Bridgette Denise Mack, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2001031951 Issued in MO

Practice address

312 SW Greenwich Dr Ste 733
Lees Summit, MO 64082-4408

Phone

(913) 712-0565

Fax

(816) 537-8605

NPI assigned

Jun 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642809600000",
    "number": "1144423625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6216 SWOPE PKWY",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641304447",
            "telephone_number": "913-687-8795",
            "fax_number": "816-537-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 SW GREENWICH DR STE 733",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640824408",
            "telephone_number": "913-712-0565",
            "fax_number": "816-537-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "BRIDGETTE",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2022-01-22",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2001031951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "499012508",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Lee Lyday, DPT
• Kristen Lynch, PT
• Perry E Lyon, LPC
• M a Mirza, LLC
• Kristi K Mace
• Camri Mack, RN
• Daphne Mack, LPC
• Kinsey Ann Maddox, OT
• Madhukar Chhatre MD PC
• Erica Magruder, PT, DPT

• Professional Counselor in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.