MEDICARE: MICHELLE RENEE MACKEY LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0001331	CO
2	101YP2500X	Professional Counselor	7233	TN
3	101YP2500X	Professional Counselor	LPC.0014007	CO

General Provider Information

NPI Number	:	1932627205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE MACKEY LPC

Provider Business Mailing Address
First Line	:	5743 WESTERN AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-2225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5743 WESTERN AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-2225
Country	:	US
Telephone Number	:	719-359-7514
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	01/06/2026

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