Provider Demographics
NPI:1194547794
Name:BANNISTER, MACKENZIE FRANCES (MFT-A)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:FRANCES
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 11TH AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5326
Mailing Address - Country:US
Mailing Address - Phone:425-576-1817
Mailing Address - Fax:
Practice Address - Street 1:312 11TH AVE W STE 201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5326
Practice Address - Country:US
Practice Address - Phone:425-576-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61570171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist