Active NPI
Mackenzie Moak
- School Counselor
- Davis, CA
National Provider Identifier
1790656304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- License
- 250140594
- Practice address
- 1600 Birch LN
Davis, CA 95618-1450 - Phone
- (530) 757-5395
- NPI assigned
- Sep 16, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 250140594 | CA | Primary |
Addresses
Primary practice location
1600 Birch LN
Davis, CA 95618-1450
Mailing address
1600 Birch LN
Davis, CA 95618-1450
Phone (530) 757-5395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 250140594 | CA | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757980800000",
"number": "1790656304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 BIRCH LN",
"city": "DAVIS",
"state": "CA",
"postal_code": "956181450",
"telephone_number": "530-757-5395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 BIRCH LN",
"city": "DAVIS",
"state": "CA",
"postal_code": "956181450",
"telephone_number": "530-757-5395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOAK",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-16",
"last_updated": "2025-09-16",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "CA",
"license": "250140594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.