MEDICARE: MRS. HELEN E MCKINZIE LCSW

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	1041C0700X	Clinical Social Worker	59771	TX
2	1041C0700X	Clinical Social Worker	LCSW-18921	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59771	OTHER	TX	TEXAS STATE BOARD OF SOCIAL WORK EXAMINERS

General Provider Information

NPI Number	:	1902364722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELEN E MCKINZIE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3630
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86003-3630
Country	:	US
Telephone Number	:	928-522-9879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W UNIVERSITY AVE
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-2851
Country	:	US
Telephone Number	:	928-522-1300
Fax Number	:	928-522-1300

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

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	06/10/2025

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