Provider Demographics
NPI:1043041999
Name:JAIME MCKENZIE, LMHC, LLC
Entity type:Organization
Organization Name:JAIME MCKENZIE, LMHC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-200-4619
Mailing Address - Street 1:107 BEN HILL GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:FL
Mailing Address - Zip Code:33960-2025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 BEN HILL GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:FL
Practice Address - Zip Code:33960-2025
Practice Address - Country:US
Practice Address - Phone:470-243-0402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)