Provider Demographics
NPI:1447512744
Name:MACKENZIE, JORRIE STUART (PHD)
Entity type:Individual
Prefix:DR
First Name:JORRIE
Middle Name:STUART
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1515
Mailing Address - Country:US
Mailing Address - Phone:657-204-9303
Mailing Address - Fax:
Practice Address - Street 1:6881 PREAKNESS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1515
Practice Address - Country:US
Practice Address - Phone:657-204-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27060103TC0700X
CAPSY27060103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical