Provider Demographics
NPI:1538205844
Name:MCKENZIE, BRIAN LEE (QMHA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7680 SW 74TH AVE
Mailing Address - Street 2:APT. 6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9595
Mailing Address - Country:US
Mailing Address - Phone:503-547-4991
Mailing Address - Fax:
Practice Address - Street 1:2415 SE 42ND
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-872-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker