Provider Demographics
NPI:1437467016
Name:BLU, MACKENSIE N/A (MFT)
Entity type:Individual
Prefix:
First Name:MACKENSIE
Middle Name:N/A
Last Name:BLU
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POBOX95
Mailing Address - Street 2:MACKENSIE BLU
Mailing Address - City:WOODBURY AVE
Mailing Address - State:TN
Mailing Address - Zip Code:37190
Mailing Address - Country:US
Mailing Address - Phone:615-542-5068
Mailing Address - Fax:
Practice Address - Street 1:826 MEMORIAL AVE
Practice Address - Street 2:MACKENSIE BLU
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-542-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN260101Y00000X, 101YA0400X, 101YM0800X, 106H00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator