Provider Demographics
NPI:1861609281
Name:MCMACKIN, MARY CATHERINE (LCPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:MCMACKIN
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S RUTAN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1138
Mailing Address - Country:US
Mailing Address - Phone:316-686-4283
Mailing Address - Fax:
Practice Address - Street 1:230 S RUTAN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1138
Practice Address - Country:US
Practice Address - Phone:316-686-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS305101YM0800X
KS589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist