Provider Demographics
NPI:1710254859
Name:MACK, ANN MAGDALENE (LPC-MH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MAGDALENE
Last Name:MACK
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MAGDALENE
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 S DEWBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-1406
Mailing Address - Country:US
Mailing Address - Phone:605-254-0965
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health