Provider Demographics
NPI:1912756297
Name:MAY, MCKENZIE BLAKELY (ACMHC)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:BLAKELY
Last Name:MAY
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:BLAKELY
Other - Middle Name:
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACMHC
Mailing Address - Street 1:318 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4376 S 700 E STE 200
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-3077
Practice Address - Country:US
Practice Address - Phone:385-272-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty