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General NPI Number Information
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NPI Number | 1356426449
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Entity Type | Individual
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Provider Name | GARRY MACKOUL LMHC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 947 ROUTE 6A SUITE 7
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City | YARMOUTH PORT
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State | MA
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Zip | 02675-2171
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Country | US
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Telephone | 508-375-0155
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Fax | 508-375-0155
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Provider Business Mailing Address
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Address Line | 947 ROUTE 6A SUITE 7
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City | YARMOUTH PORT
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State | MA
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Zip | 02675-2171
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Country | US
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Telephone | 508-375-0155
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Fax | 508-375-0155
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3766
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1079
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License Number State | MA
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