Provider Demographics
NPI:1407925191
Name:MACK, MARIA A (P-MHNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:MACK
Suffix:
Gender:F
Credentials:P-MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S MACGREGOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1032
Mailing Address - Country:US
Mailing Address - Phone:713-741-5000
Mailing Address - Fax:713-741-5049
Practice Address - Street 1:2800 S MACGREGOR WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1032
Practice Address - Country:US
Practice Address - Phone:713-741-5000
Practice Address - Fax:713-741-5049
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598398363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3076Medicare PIN