Provider Demographics
NPI:1144763657
Name:MACK, ALLISON (LPCC)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9273
Mailing Address - Country:US
Mailing Address - Phone:270-705-2779
Mailing Address - Fax:
Practice Address - Street 1:2138 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7110
Practice Address - Country:US
Practice Address - Phone:270-449-1601
Practice Address - Fax:270-220-0594
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100876200Medicaid