Basic Information
| Provider Information | |||||||||
| NPI: | 1336292820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | JANELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 470064 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900479564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132198182 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9864 BALDWIN PL | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264331311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY27389 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.