Provider Demographics
NPI:1710165683
Name:MACK, DON (MFT)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:MACK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GOUGH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4464
Mailing Address - Country:US
Mailing Address - Phone:415-820-9620
Mailing Address - Fax:
Practice Address - Street 1:414 GOUGH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4464
Practice Address - Country:US
Practice Address - Phone:415-820-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-03
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist