Provider Demographics
NPI:1245523943
Name:MACK, TOSHI R (MED, LPC)
Entity type:Individual
Prefix:
First Name:TOSHI
Middle Name:R
Last Name:MACK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9598
Mailing Address - Country:US
Mailing Address - Phone:610-297-3410
Mailing Address - Fax:
Practice Address - Street 1:1013 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9598
Practice Address - Country:US
Practice Address - Phone:610-297-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional