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NPI Code Detail

MEDICARE: MARY LYNNE MACK PHD

MEDICARE: MARY LYNNE MACK PHD
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
1103T00000XPsychologistPSY-005478AZ
2103T00000XPsychologist2598-057WI

General Provider Information

NPI Number : 1700811015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LYNNE MACK PHD
Provider Business Mailing Address
First Line : 1647 N SIERRA VISTA DR
Second Line :
City : TEMPE
State : AZ
Zip : 85288-1462
Country : US
Telephone Number : 480-737-6076
Fax Number :
Provider Business Practice Location Address
First Line : 5635 N SCOTTSDALE RD STE 170
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85250-5945
Country : US
Telephone Number : 480-737-6076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 03/29/2026

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Directions to “ MARY LYNNE MACK PHD” Practice Location

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