Healthcare Provider Details

I. General information

NPI: 1194139535
Provider Name (Legal Business Name): MACKIE YAUSSI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SE 25TH ST
TOPEKA KS
66605-1734
US

IV. Provider business mailing address

130 E 5TH ST PO BOX 711
NEWTON KS
67114-2206
US

V. Phone/Fax

Practice location:
  • Phone: 785-267-0561
  • Fax: 785-267-0573
Mailing address:
  • Phone: 316-283-6743
  • Fax: 316-283-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number067
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: