MEDICARE: MCKENZIE NICOLE HARTLEY

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	604529709	WA

General Provider Information

NPI Number	:	1689561524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE NICOLE HARTLEY

Provider Business Mailing Address
First Line	:	PO BOX 134
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851-0134
Country	:	US
Telephone Number	:	509-492-1096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 PACIFIC ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-4656
Country	:	US
Telephone Number	:	360-472-0528
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	07/08/2025

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Directions to “ MCKENZIE NICOLE HARTLEY ” Practice Location

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