Provider Demographics
NPI:1669935870
Name:MCKENZIE, ASHLEY MOZELLE (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MOZELLE
Last Name:MCKENZIE
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 1:22367 WITTE FALLS LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7801
Mailing Address - Country:US
Mailing Address - Phone:918-839-7187
Mailing Address - Fax:
Practice Address - Street 1:1620 S 46TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3129
Practice Address - Country:US
Practice Address - Phone:479-494-7889
Practice Address - Fax:479-494-7890
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9395-M104100000X
AR9395-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker