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General NPI Number Information
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NPI Number | 1720586597
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Entity Type | Organization
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Legal Business Name | CHAMISA MACKENZIE, LMSW, LLC
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 202 E WASHINGTON ST STE 401
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City | ANN ARBOR
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State | MI
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Zip | 48104-2017
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Country | US
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Telephone | 734-649-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 HELEN ST
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City | ANN ARBOR
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State | MI
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Zip | 48103-2478
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Country | US
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Telephone | 734-649-4114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN CHAMISA MACKENZIE
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Credential | LMSW
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Telephone | 734-649-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | MI
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