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General NPI Number Information
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NPI Number | 1578161824
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Entity Type | Individual
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Provider Name | MACKENZIE GLASS
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Gender | Female
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 5226 HARBINGER RD
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City | SPRING HILL
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State | FL
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Zip | 34608-2046
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Country | US
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Telephone | 724-766-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 8526 HUNTSMAN LN
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City | PORT RICHEY
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State | FL
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Zip | 34668-2016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-138850
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License Number State | FL
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