Provider Demographics
NPI:1366435844
Name:MACKENZIE, JAMES ANDREW (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 N 44TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3011
Mailing Address - Country:US
Mailing Address - Phone:602-239-2638
Mailing Address - Fax:602-239-2067
Practice Address - Street 1:1300 N 12TH ST # 605
Practice Address - Street 2:BANNER FAMILY MEDICINE CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2898
Practice Address - Country:US
Practice Address - Phone:602-239-2638
Practice Address - Fax:602-239-2067
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1110103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ66493Medicare ID - Type Unspecified