Provider Demographics
NPI:1659497055
Name:RICHARD N. MACK
Entity Type:Organization
Organization Name:RICHARD N. MACK
Other - Org Name:MARRIAGE & FAMILY THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, LMFT
Authorized Official - Phone:210-967-9201
Mailing Address - Street 1:2700 NE LOOP 410
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4840
Mailing Address - Country:US
Mailing Address - Phone:210-967-9201
Mailing Address - Fax:210-967-9560
Practice Address - Street 1:2700 NE LOOP 410
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4840
Practice Address - Country:US
Practice Address - Phone:210-967-9201
Practice Address - Fax:210-967-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60877101YP2500X
TX001572106H00000X
TX200897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty