Doctor Name: | GENELLE JO MACKEY |
NPI Number: | 1033308549 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | LCSW-27517 |
Business Practice Address: | 685 N Oregon St Ontario, OR - 979141724 |
Business Phone Number: | 5418892219 |
Business Fax Number: | |
Mailing Address: | 863 Morgan Ave, ONTARIO |
State: | OR |
Postal Code: | 979148659 |
Phone Number: | 5418896123 |
Fax Number: | 5418896123 |
NPI Enumeration Date: | 10/20/2007 |
NPI Last Update Date: | 10/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW-27517 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |