Individual
MACKENZIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., BCBA, LBA
Contact information
Practice address
300 7TH AVE SW, MAGEE, MS 39111
(601) 259-1388
Mailing address
620 S 28TH AVE APT 104, HATTIESBURG, MS 39402-2519
(601) 754-8224
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
220102
MS
106S00000X
Behavior Technician
RBT-20-136750
MS
Other
Enumeration date
10/02/2020
Last updated
11/13/2023
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