Provider Demographics
NPI:1174338909
Name:MILLER, MACKENZIE ANN (LAPC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7126 LINCOLN HWY W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17364-9207
Mailing Address - Country:US
Mailing Address - Phone:717-880-9741
Mailing Address - Fax:
Practice Address - Street 1:327 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2505
Practice Address - Country:US
Practice Address - Phone:717-632-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional