Provider Demographics
NPI:1861868804
Name:MACK, ERIN (MA, LPC, QMHP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:MA, LPC, QMHP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 S SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2727
Mailing Address - Country:US
Mailing Address - Phone:605-336-0510
Mailing Address - Fax:605-336-3779
Practice Address - Street 1:2000 S SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2727
Practice Address - Country:US
Practice Address - Phone:605-336-0510
Practice Address - Fax:605-336-3779
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional