Jessie Jean Mackenzie, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

0104321 Issued in NM

Practice address

360 Fog Road
Espanola, NM 87532

Phone

(505) 692-6315

Fax

(505) 692-6341

NPI assigned

Dec 7, 2006

Last updated

Nov 1, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Santa Clara Pueblo

  • Counselor
  • Espanola, NM
  • NPI 1407147994
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509494400000",
    "number": "1306905104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 CALLE MEJIA APT 202",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011462",
            "telephone_number": "505-728-0286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 FOG ROAD",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "87532",
            "telephone_number": "505-692-6315",
            "fax_number": "505-692-6341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "JESSIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-07",
        "last_updated": "2017-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NM",
            "license": "0104321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57953767",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Lujan
• Leticia A Luketich Martinez, CNP
• Lisa Luttbeg, MA
• Luz de Vida LLC
• Elizabeth Lykins, LMHC
• Feral A Macloud, DOM
• Frances M Madrid, R.N.
• Marissa M Maestas, CSW
• Destiny Maestas
• Dominic Maestas

• Marriage & Family Therapist in Espanola, NM
• Providers in Espanola, NM by specialty
• Marriage & Family Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.