Provider Demographics
NPI:1174114631
Name:SCHMID, MACKENZIE BLAIR (MS)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:BLAIR
Last Name:SCHMID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5549 HWY K, BRIGHTON, MO 65617
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65617
Mailing Address - Country:US
Mailing Address - Phone:417-376-2238
Mailing Address - Fax:
Practice Address - Street 1:5549 HWY K, BRIGHTON, MO 65617
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MO
Practice Address - Zip Code:65617
Practice Address - Country:US
Practice Address - Phone:417-376-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health