Provider Demographics
NPI:1528874047
Name:SPROWLS, MCKENZIE RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:RENEE
Last Name:SPROWLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 OAKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7181
Mailing Address - Country:US
Mailing Address - Phone:918-399-0213
Mailing Address - Fax:
Practice Address - Street 1:2917 NW 156TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2101
Practice Address - Country:US
Practice Address - Phone:918-399-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty