Provider Demographics
NPI:1861905051
Name:DR. TARI MACK, INC.
Entity type:Organization
Organization Name:DR. TARI MACK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARI
Authorized Official - Middle Name:N
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-307-8148
Mailing Address - Street 1:636 CHURCH ST STE 415
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4580
Mailing Address - Country:US
Mailing Address - Phone:773-307-8148
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 415
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4580
Practice Address - Country:US
Practice Address - Phone:773-307-8148
Practice Address - Fax:773-307-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
071.007514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty