Provider Demographics
NPI:1528504057
Name:THREADGILL, MACKENZIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LITTLE ELM PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1919
Mailing Address - Country:US
Mailing Address - Phone:214-708-8617
Mailing Address - Fax:
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1919
Practice Address - Country:US
Practice Address - Phone:214-708-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX83018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health