MEDICARE: MACKENZIE BERG

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	:	1619812468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE BERG

Provider Business Mailing Address
First Line	:	15439 OLD HICKORY BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-6272
Country	:	US
Telephone Number	:	707-978-8332
Fax Number	:

Provider Business Practice Location Address
First Line	:	15439 OLD HICKORY BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-6272
Country	:	US
Telephone Number	:	707-978-8332
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ MACKENZIE BERG ” Practice Location

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