Provider Demographics
NPI:1386488278
Name:MARSHALL, MACKENZIE (LPC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 GRACEFUL ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4011
Mailing Address - Country:US
Mailing Address - Phone:719-660-3988
Mailing Address - Fax:
Practice Address - Street 1:323 W DRAKE RD STE 124
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8123
Practice Address - Country:US
Practice Address - Phone:970-800-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019779101YM0800X
COLPC.0021095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health