MEDICARE: MS. MARY CATHERINE MCMACKIN LCPC, LMFT

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	101YM0800X	Mental Health Counselor	305	KS
2	106H00000X	Marriage & Family Therapist	589	KS

General Provider Information

NPI Number	:	1861609281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHERINE MCMACKIN LCPC, LMFT

Provider Business Mailing Address
First Line	:	230 S RUTAN ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1138
Country	:	US
Telephone Number	:	316-686-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 S RUTAN ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1138
Country	:	US
Telephone Number	:	316-686-4283
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	09/11/2025

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