Provider Demographics
NPI:1477435675
Name:VAN GEFFEN, MCKENZIE (MA)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:VAN GEFFEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 WOLF WALK WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4098
Mailing Address - Country:US
Mailing Address - Phone:830-515-8591
Mailing Address - Fax:
Practice Address - Street 1:1067 FM 306 STE 402
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6895
Practice Address - Country:US
Practice Address - Phone:830-312-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health