MEDICARE: MEKENZIE JESSI SUTTON LMHC, CN

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	MHC.LH.61489019	WA
2	133N00000X	Nutritionist	NUTR.NU.61096202	WA

General Provider Information

NPI Number	:	1912519976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEKENZIE JESSI SUTTON LMHC, CN

Provider Business Mailing Address
First Line	:	10724 VERNON RD
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8500
Country	:	US
Telephone Number	:	425-953-8073
Fax Number	:

Provider Business Practice Location Address
First Line	:	10724 VERNON RD
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8500
Country	:	US
Telephone Number	:	425-953-8073
Fax Number	:

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	05/09/2026

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