Individual
MACKENZIE WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA NCC MFT-A
Contact information
Practice address
1029 MAY ST STE G, HOOD RIVER, OR 97031-1514
(541) 203-0912
Mailing address
PO BOX 1452, HOOD RIVER, OR 97031-0452
(541) 203-0912
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
R8141
OR
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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