Provider Demographics
NPI:1558000562
Name:TRESNAK, MACKENZIE (PSYD, LP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:TRESNAK
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:GLAROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3323 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3143
Mailing Address - Country:US
Mailing Address - Phone:248-914-1314
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD STE 110
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558000562Medicaid