MEDICARE: MR. JOEL MACKEY LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	18275	CA
2	101YM0800X	Mental Health Counselor	61480738	WA

General Provider Information

NPI Number	:	1518730639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL MACKEY LMHC

Provider Business Mailing Address
First Line	:	5539 DEER RUN DR
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3871
Country	:	US
Telephone Number	:	510-262-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	5539 DEER RUN DR
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3871
Country	:	US
Telephone Number	:	510-262-0564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	02/12/2025

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