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General NPI Number Information
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NPI Number | 1871019844
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Entity Type | Individual
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Provider Name | MACKENZIE TAYLOR RICE
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 6202 CONSTITUTION DR STE D
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City | FORT WAYNE
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State | IN
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Zip | 46804-1583
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Country | US
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Telephone | 260-432-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 6202 CONSTITUTION DR STE D
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City | FORT WAYNE
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State | IN
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Zip | 46804-1583
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39004077A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20043940A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 20043940B
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License Number State | IN
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