Basic Information
| Provider Information | |||||||||
| NPI: | 1932277449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKENZIE | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2030 DIVISION ST | ||||||||
| Address2: | B | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762020 | ||||||||
| FaxNumber: | 3607342106 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 DIVISION ST | ||||||||
| Address2: | B | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762020 | ||||||||
| FaxNumber: | 3607342106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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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 | 101YA0400X | CP00000280 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.