Active NPI
Vivian Renee Mack, LPC
- Professional Counselor
- Saint Louis, MO
National Provider Identifier
1548307663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2006009257
- Practice address
- 330 N Gore Ave
Saint Louis, MO 63119-1600 - Phone
- (314) 968-2060
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P0509060 | AR | |
| Professional Counselor | 101YP2500X | 2006009257 | MO | Primary |
Addresses
Primary practice location
330 N Gore Ave
Saint Louis, MO 63119-1600
Mailing address
330 N Gore Ave
Saint Louis, MO 63119-1600
Phone (314) 968-2060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5A021 | Other | AR | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0509060 | AR | MD | Professional Counselor |
| 2006009257 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473379200000",
"number": "1548307663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 N GORE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631191600",
"telephone_number": "314-968-2060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 N GORE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631191600",
"telephone_number": "314-968-2060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "VIVIAN",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2016-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P0509060",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2006009257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5A021",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.