=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649789470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AARYN C MACKEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 09/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 N IRWIN ST
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-728-4127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 942
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93232-0942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
Name | AARYN C MACKEY
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 559-728-4127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MFT100344
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------