Basic Information
| Provider Information | |||||||||
| NPI: | 1750615571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | JEAN | ||||||||
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| Credential: | M.S., M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 SW RAMSEY AVE | ||||||||
| Address2: | KAIROS ADMINISTRATION OFFICES | ||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414613075 | ||||||||
| FaxNumber: | 5419565463 | ||||||||
| Practice Location | |||||||||
| Address1: | 348 RUBY AVE | ||||||||
| Address2: | KAIROS TEMPO YOUNG ADULT SERVICES (RTH) | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974042033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414613075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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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 | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.