MEDICARE: CHRISTINE DENISE MACKEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CTB-2026-0158.	NM
2	101YP2500X	Professional Counselor	C11374	OR
3	101YP2500X	Professional Counselor	C.2002834	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C.2002834	OTHER	OH	LPC
2	C.1801172-TRNE	OTHER	OH	COUNSELOR TRAINEE

General Provider Information

NPI Number	:	1447731054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE DENISE MACKEY

Provider Business Mailing Address
First Line	:	1259 S HIGH ST APT 2
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-3432
Country	:	US
Telephone Number	:	440-725-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 RICHLAND AVE
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-3700
Country	:	US
Telephone Number	:	845-769-8758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	03/04/2026

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Directions to “ CHRISTINE DENISE MACKEY ” Practice Location

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