Individual
MACKENZIE HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
88 S MAIN ST STE 2, GLEN CARBON, IL 62034-1415
(618) 288-8085
(618) 288-8959
Mailing address
PO BOX 639, GLEN CARBON, IL 62034-0639
(618) 288-8085
(618) 288-8959
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4A00-IPI-032
—
IL
Enumeration date
07/23/2020
Last updated
06/18/2021
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