Individual
JASON MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
105 BRANDON WAY, SUITE A, MOUNT STERLING, KY 40353-8500
(859) 762-0175
Mailing address
PO BOX 726, LOUISA, KY 41230-0726
(859) 762-0175
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1296
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30610026
—
KY
Enumeration date
04/09/2010
Last updated
11/18/2015
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