Provider Demographics
NPI:1609933498
Name:SKODJE-MACK, BARBARA (EDD, LMFT, LPCC)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:SKODJE-MACK
Suffix:
Gender:F
Credentials:EDD, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S 2ND ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3626
Mailing Address - Country:US
Mailing Address - Phone:507-387-1350
Mailing Address - Fax:507-387-6605
Practice Address - Street 1:1900 CENTRACARE CIR STE 1000
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5199
Practice Address - Fax:202-295-1413
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98101YM0800X
MN1417106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01044729OtherPREFERRED ONE
MN136391OtherUCARE
MN098402000Medicaid
MN155H2SKOtherBLUE CROSS BLUE SHIELD
MNHP56449OtherHEALTH PARTNERS