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NPI Code Detail

MEDICARE: KEYSHA MACK

MEDICARE: KEYSHA MACK
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
1101YM0800XMental Health Counselor101Y00000XOH

General Provider Information

NPI Number : 1528926383
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEYSHA MACK
Provider Business Mailing Address
First Line : 1490 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43205-2140
Country : US
Telephone Number : 614-252-0731
Fax Number : 614-252-8468
Provider Business Practice Location Address
First Line : 1490 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43205-2140
Country : US
Telephone Number : 614-252-0731
Fax Number : 614-252-8468
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ KEYSHA MACK ” Practice Location

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