Provider Demographics
NPI:1710254859
Name:MACK, ANN MAGDALENE (LPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MAGDALENE
Last Name:MACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MAGDALENE
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 W 69TH ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8171
Mailing Address - Country:US
Mailing Address - Phone:605-322-5845
Mailing Address - Fax:605-322-5940
Practice Address - Street 1:4400 W 69TH ST STE 1500
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8171
Practice Address - Country:US
Practice Address - Phone:605-322-5845
Practice Address - Fax:605-322-5940
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health