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General NPI Number Information
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NPI Number | 1891235255
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Entity Type | Individual
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Provider Name | MACKENZIE LYN BROSSART LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1750 MARKET DR STE H
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City | DICKINSON
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State | ND
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Zip | 58601-6181
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Country | US
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Telephone | 701-456-1221
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Fax | 888-720-5313
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Provider Business Mailing Address
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Address Line | 387 15TH ST W # 117
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City | DICKINSON
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State | ND
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Zip | 58601-3017
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Country | US
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Telephone | 701-456-1221
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Fax | 888-720-5313
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5427
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License Number State | ND
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