Brenda Kay Mack, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC40160 Issued in CA

Practice address

7227 Broadway
Suite 302
Lemon Grove, CA 91945-1500

Phone

(619) 546-8012

Fax

(619) 546-8012

NPI assigned

Apr 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 CA

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

Marriage and Family Therapist

Education

University of California, San Diego School of Medicine, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• K'Ima:W Medical Center

  • Clinic/Center
  • Hoopa, CA
  • NPI 1306904222
  Medicare reassignment

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447371075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 BROADWAY",
            "address_2": "SUITE 302",
            "city": "LEMON GROVE",
            "state": "CA",
            "postal_code": "919451500",
            "telephone_number": "619-546-8012",
            "fax_number": "619-546-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7227 BROADWAY",
            "address_2": "SUITE 302",
            "city": "LEMON GROVE",
            "state": "CA",
            "postal_code": "919451500",
            "telephone_number": "619-546-8012",
            "fax_number": "619-546-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "BRENDA",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC40160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MFC40160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake Anthony Lucas
• Stephanie Lue
• Jeannie Luna
• M Dot O Services
• Charlotte Macera
• Donyale Mack
• Andrea Maldonado
• Mehmood Fatehali Manji, DDS
• Triana Marasigan
• Sabra G Marquez

• Marriage & Family Therapist in Lemon Grove, CA
• Providers in Lemon Grove, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.