MEDICARE: DR. JAMES ANDREW MACKENZIE PH.D., M.S.W.

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	103TC1900X	Counseling Psychologist	1110	AZ

General Provider Information

NPI Number	:	1366435844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ANDREW MACKENZIE PH.D., M.S.W.

Provider Business Mailing Address
First Line	:	11220 N 44TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3011
Country	:	US
Telephone Number	:	602-239-2638
Fax Number	:	602-239-2067

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST # 605
Second Line	:	BANNER FAMILY MEDICINE CENTER
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2898
Country	:	US
Telephone Number	:	602-239-2638
Fax Number	:	602-239-2067

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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