Provider Demographics
NPI:1063043800
Name:MACKO, MARK STEVEN (LMHC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:MACKO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4786 HAMLETS GROVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235
Mailing Address - Country:US
Mailing Address - Phone:941-413-6869
Mailing Address - Fax:
Practice Address - Street 1:4786 HAMLETS GROVE DRIVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235
Practice Address - Country:US
Practice Address - Phone:941-413-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2024-11-04
Deactivation Date:2023-01-24
Deactivation Code:
Reactivation Date:2024-10-22
Provider Licenses
StateLicense IDTaxonomies
FLMH4013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty