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General NPI Number Information
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NPI Number | 1811424757
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Entity Type | Individual
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Provider Name | DEVAN MCKENZIE
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Gender | Female
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 9014 S CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85042-8304
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Country | US
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Telephone | 602-230-7373
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Fax | 602-441-5839
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Provider Business Mailing Address
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Address Line | 16180 W IRONWOOD ST
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City | SURPRISE
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State | AZ
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Zip | 85374-5831
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC-15836
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-18165
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License Number State | AZ
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