Provider Demographics
NPI:1235972787
Name:DEAN, MACKENA MARIE (APCC)
Entity type:Individual
Prefix:
First Name:MACKENA
Middle Name:MARIE
Last Name:DEAN
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 N FRESNO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5265
Mailing Address - Country:US
Mailing Address - Phone:559-528-8880
Mailing Address - Fax:
Practice Address - Street 1:6061 N FRESNO ST STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5265
Practice Address - Country:US
Practice Address - Phone:559-528-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health