Healthcare Provider Details

I. General information

NPI: 1609933498
Provider Name (Legal Business Name): BARBARA SKODJE-MACK EDD, LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 1000
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR STE 1000
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-5199
  • Fax: 202-295-1413
Mailing address:
  • Phone: 320-229-4945
  • Fax: 320-229-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1417
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: