Individual
MACKENZIE VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
47915 OASIS ST UNIT C, INDIO, CA 92201-6950
(442) 282-4909
Mailing address
PO BOX 13084, PALM DESERT, CA 92255-3084
(760) 289-2212
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/29/2024
Last updated
09/02/2025
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