Individual
MACKENZIE R BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6799 E TEXAS ST, BOSSIER CITY, LA 71111-6931
(318) 616-2336
(318) 616-2336
Mailing address
6799 E TEXAS ST, BOSSIER CITY, LA 71111-6931
(318) 616-2336
(318) 616-1857
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
C-179
LA
Other
Enumeration date
08/19/2025
Last updated
08/19/2025
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