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NPI Code Detail

MEDICARE: MACKENZIE THREADGILL MS, LPC

MEDICARE: MACKENZIE THREADGILL MS, LPC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor83018TX

General Provider Information

NPI Number : 1528504057
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE THREADGILL MS, LPC
Provider Business Mailing Address
First Line : 2601 LITTLE ELM PKWY STE 103
Second Line :
City : LITTLE ELM
State : TX
Zip : 75068-1919
Country : US
Telephone Number : 214-708-8617
Fax Number :
Provider Business Practice Location Address
First Line : 2601 LITTLE ELM PKWY STE 103
Second Line :
City : LITTLE ELM
State : TX
Zip : 75068-1919
Country : US
Telephone Number : 214-708-8617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2017
Last Update Date : 06/01/2023

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