Provider Demographics
NPI:1336959287
Name:GROCE, MACKENZIE MICHELLE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MICHELLE
Last Name:GROCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46147-8805
Mailing Address - Country:US
Mailing Address - Phone:317-389-7080
Mailing Address - Fax:
Practice Address - Street 1:618 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3684
Practice Address - Country:US
Practice Address - Phone:317-731-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-20-149287106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician