MEDICARE: MACKENZIE RACHELLE ZALUCKI

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

General Provider Information

NPI Number	:	1609438670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE RACHELLE ZALUCKI

Provider Business Mailing Address
First Line	:	47976 SANDY RIDGE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-5921
Country	:	US
Telephone Number	:	586-260-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	3069 UNIVERSITY DR
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2324
Country	:	US
Telephone Number	:	248-613-5377
Fax Number	:

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

Provider Enumeration Date	:	06/30/2019
Last Update Date	:	06/30/2019

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