Provider Demographics
NPI:1699006270
Name:MACK, PATRICIA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:KARL
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:544 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3053
Mailing Address - Country:US
Mailing Address - Phone:630-880-8445
Mailing Address - Fax:630-953-2559
Practice Address - Street 1:2100 MANCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4593
Practice Address - Country:US
Practice Address - Phone:630-880-8445
Practice Address - Fax:630-953-2559
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist