Provider Demographics
NPI:1497395347
Name:MACKENSWORTH, FAITH (LMHC, MS)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:MACKENSWORTH
Suffix:
Gender:F
Credentials:LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1246
Mailing Address - Country:US
Mailing Address - Phone:219-263-6058
Mailing Address - Fax:
Practice Address - Street 1:604 E PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1246
Practice Address - Country:US
Practice Address - Phone:219-263-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health