Provider Demographics
NPI:1699808345
Name:MACK, KRIS DONNA (MS, MFT)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:DONNA
Last Name:MACK
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1410
Mailing Address - Country:US
Mailing Address - Phone:805-644-1650
Mailing Address - Fax:805-644-6682
Practice Address - Street 1:500 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1410
Practice Address - Country:US
Practice Address - Phone:805-644-1650
Practice Address - Fax:805-644-6682
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health