MEDICARE: ALRETHA MCKENZIE BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH26743	FL
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346608544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALRETHA MCKENZIE BS

Provider Business Mailing Address
First Line	:	6917 MAKATI DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3280
Country	:	US
Telephone Number	:	863-709-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	6917 MAKATI DR.
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3280
Country	:	US
Telephone Number	:	863-709-6443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	03/18/2026

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