Provider Demographics
NPI:1063681096
Name:SKYE, MACKENZIE LINDY (PHD, LMFT, BCETS)
Entity type:Individual
Prefix:PROF
First Name:MACKENZIE
Middle Name:LINDY
Last Name:SKYE
Suffix:
Gender:F
Credentials:PHD, LMFT, BCETS
Other - Prefix:
Other - First Name:LINDY
Other - Middle Name:GAIL
Other - Last Name:SMITH-SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LMFT
Mailing Address - Street 1:202 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3959
Mailing Address - Country:US
Mailing Address - Phone:707-386-1295
Mailing Address - Fax:
Practice Address - Street 1:202 ROYAL CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3959
Practice Address - Country:US
Practice Address - Phone:707-386-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist