Healthcare Provider Details

I. General information

NPI: 1386829380
Provider Name (Legal Business Name): KATHLEEN A. MACK, PSY.D,. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TRIANGLE PARK DR
CINCINNATI OH
45246-3404
US

IV. Provider business mailing address

PO BOX 674
LOVELAND OH
45140-0674
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-8555
  • Fax: 513-771-8556
Mailing address:
  • Phone: 513-771-8555
  • Fax: 513-771-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3898
License Number StateOH

VIII. Authorized Official

Name: DR. KATHLEEN A. MACK
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 513-771-8555