Provider Demographics
NPI:1720245079
Name:MACKENZIE, ALEXANDER J (MFT, CEAP)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:J
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HAVANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4460
Mailing Address - Country:US
Mailing Address - Phone:562-331-0010
Mailing Address - Fax:
Practice Address - Street 1:5855 E NAPLES PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5060
Practice Address - Country:US
Practice Address - Phone:562-331-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist