Provider Demographics
NPI:1811687114
Name:MACKEY, MICHAEL DAVID (BS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:MACKEY
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WERNLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7015
Mailing Address - Country:US
Mailing Address - Phone:765-966-2506
Mailing Address - Fax:
Practice Address - Street 1:2000 WERNLE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7015
Practice Address - Country:US
Practice Address - Phone:765-966-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children