MEDICARE: MACKENZIE LEA KERBER LPCC

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	CC01236	MN

General Provider Information

NPI Number	:	1831541168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE LEA KERBER LPCC

Provider Business Mailing Address
First Line	:	3464 WASHINGTON DR STE 115
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1453
Country	:	US
Telephone Number	:	651-348-8551
Fax Number	:	651-409-2029

Provider Business Practice Location Address
First Line	:	3464 WASHINGTON DR STE 115
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1453
Country	:	US
Telephone Number	:	651-348-8551
Fax Number	:	651-409-2029

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/14/2021

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