Provider Demographics
NPI:1235607086
Name:MACK, ALLISON (BA, MS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 PIONEER CT STE B
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1736
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-638-1602
Practice Address - Street 1:2015 PIONEER CT STE B
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1736
Practice Address - Country:US
Practice Address - Phone:506-348-6603
Practice Address - Fax:650-638-1602
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist