Provider Demographics
NPI:1295334514
Name:FYE MCCAIN, MACKENZIE E (PSYD)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:E
Last Name:FYE MCCAIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MACKENZIE
Other - Middle Name:E
Other - Last Name:FYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 7410264
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0264
Mailing Address - Country:US
Mailing Address - Phone:815-942-6323
Mailing Address - Fax:779-210-5541
Practice Address - Street 1:111 N WABASH AVE STE 1116
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3126
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical