Provider Demographics
NPI:1073960795
Name:CONDIE, MAKAYLA (LCPC, CMHC, LPCC)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:CONDIE
Suffix:
Gender:F
Credentials:LCPC, CMHC, LPCC
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:
Other - Last Name:BURKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, CMHC, LPCC
Mailing Address - Street 1:3355 N WHITE AVE
Mailing Address - Street 2:#7192
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-7192
Mailing Address - Country:US
Mailing Address - Phone:208-219-0425
Mailing Address - Fax:
Practice Address - Street 1:3355 N WHITE AVE
Practice Address - Street 2:#7192
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-7192
Practice Address - Country:US
Practice Address - Phone:208-219-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13852101YM0800X
UT11697949-6004101YM0800X
IDLCPC-7003101YM0800X
IDLPC - 6171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health