Provider Demographics
NPI:1902173875
Name:CLEVINGER, MAKENZIE RAE (MFTC, CACII)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:RAE
Last Name:CLEVINGER
Suffix:
Gender:F
Credentials:MFTC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371674
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-5674
Mailing Address - Country:US
Mailing Address - Phone:720-705-5026
Mailing Address - Fax:
Practice Address - Street 1:1724 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1206
Practice Address - Country:US
Practice Address - Phone:720-705-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7491101YA0400X
COMFTC.0013460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)