Provider Demographics
NPI:1407941461
Name:MACKIE, CATHERINE B (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:MACKIE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 227A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:11710 OLD BALLAS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7076
Practice Address - Country:US
Practice Address - Phone:314-567-1958
Practice Address - Fax:314-567-0037
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002407101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO179648OtherBLUE CROSS BLUE SHIELD
MO2258222OtherCIGNA