Provider Demographics
NPI:1053157297
Name:EDWARDS, MACKENZIE (LMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 CEDAR SPRINGS RD APT 331
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7201
Mailing Address - Country:US
Mailing Address - Phone:801-824-9263
Mailing Address - Fax:
Practice Address - Street 1:211 S TYLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4934
Practice Address - Country:US
Practice Address - Phone:972-590-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical