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General NPI Number Information
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NPI Number | 1700660958
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Entity Type | Individual
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Provider Name | ADAM J MACKENZIE PHD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 671 E RIVERPARK LN STE 220
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City | BOISE
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State | ID
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Zip | 83706-6559
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Country | US
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Telephone | 208-344-2071
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Fax | 208-344-2075
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Provider Business Mailing Address
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Address Line | 671 E RIVERPARK LN STE 220
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City | BOISE
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State | ID
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Zip | 83706-6559
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Country | US
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Telephone | 208-344-2071
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Fax | 208-344-2075
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1171360
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License Number State | ID
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