| Mackie Enterprises Llc | |
|
1134 Ne 70th Ave Portland OR 97213-5420 | |
| (971) 207-5010 | |
| Not Available |
| Full Name | Mackie Enterprises Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1134 Ne 70th Ave, Portland, Oregon |
| Authorized Official Name and Position | Keith John Mackie (OWNER) |
| Authorized Official Contact | 9712075010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mackie Enterprises Llc 1134 Ne 70th Ave Portland OR 97213-5420 Ph: (971) 207-5010 | Mackie Enterprises Llc 1134 Ne 70th Ave Portland OR 97213-5420 Ph: (971) 207-5010 |
| NPI Number | 1700396793 |
|---|---|
| Provider Enumeration Date | 10/04/2017 |
| Last Update Date | 02/08/2022 |
| Certification Date | 02/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700396793 | NPI | - | NPPES |
| 164936 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 07-09-29 (Oregon) | Secondary |
| 101YM0800X | Counselor - Mental Health | C2538 (Oregon) | Primary |
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