Provider Demographics
NPI:1174202006
Name:BROWN, MACKENZIE JEWELL MARY (LCSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JEWELL MARY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BEAR VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6284
Mailing Address - Country:US
Mailing Address - Phone:970-314-4080
Mailing Address - Fax:
Practice Address - Street 1:603 BEAR VALLEY CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6284
Practice Address - Country:US
Practice Address - Phone:970-314-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099294601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical