Provider Demographics
NPI:1194476846
Name:MATTINGLY, MACKENZIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:MATTINGLY
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 1:317 18TH AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2253
Mailing Address - Country:US
Mailing Address - Phone:615-332-2984
Mailing Address - Fax:
Practice Address - Street 1:317 18TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2253
Practice Address - Country:US
Practice Address - Phone:615-292-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0137301041C0700X
TNLSW00000085621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical