Coresair Anton Mack

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180012529 Issued in IL

Practice address

220 E Hillcrest Dr Apt 4210
Dekalb, IL 60115-2452

Phone

(847) 421-4613

NPI assigned

Sep 6, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mack'S Empowerment Counseling

  • Adult Mental Health Clinic/Center
  • Elgin, IL
  • NPI 1376118208
  NPD Authorized official

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

{
    "created_epoch": "1473120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1336696582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E HILLCREST DR APT 4210",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601152452",
            "telephone_number": "847-421-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E HILLCREST DR APT 4210",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601152452",
            "telephone_number": "847-421-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "CORESAIR",
        "middle_name": "ANTON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-06",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180012529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Morge Lueken, LCSW
• Clarissa Amanda Luke
• Katie Larissa Lupton
• Judith Lutz
• Abby Lynch
• Lorna K. Mackeben, RN,CNP
• Lauren Mackey, LPC
• Dawn Magnuson
• Shobha Mahadevan, M.D.
• Samar Mahmood, MD

• Professional Counselor in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.