Mackenzie, Jessie Jean

Mackenzie, Jessie Jean is an individual health care provider with primary practice located at 360 Fog Road , Espanola NM 87532. She recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as her primary health care specialty. Mackenzie, Jessie Jean can be contacted via phone (505) 692-6315.

Contact Information

Primary practice address
360 Fog Road Espanola NM 87532
Phone: (505) 692-6315
Fax: (505) 692-6341
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 0104321 New Mexico

Profile Details

NPI number 1306905104
LBN Legal business name Mackenzie, Jessie Jean
Credentials LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2006
Last updated Nov 1st, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306905104 NPPES
New Mexico MEDICAID 57953767

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