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General NPI Number Information
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NPI Number | 1063187383
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Entity Type | Individual
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Provider Name | MARK T MACHAK LPC
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Gender | Male
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 10150 W NATIONAL AVE STE 202
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City | WEST ALLIS
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State | WI
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Zip | 53227-2145
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Country | US
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Telephone | 414-617-5143
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Fax |
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Provider Business Mailing Address
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Address Line | 3929 E KLIEFORTH AVE
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City | CUDAHY
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State | WI
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Zip | 53110-3123
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Country | US
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Telephone | 414-617-5143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10668125
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License Number State | WI
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