Active NPI
Leslie Rae Mack, LPC MS NCC
- Professional Counselor
- Fargo, ND
National Provider Identifier
1689766750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5085104
- Practice address
- 510 4TH St S
Fargo, ND 58103 - Phone
- (701) 476-7200
- Fax
- (701) 476-7273
- NPI assigned
- Sep 28, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5085104 | ND | Primary |
Addresses
Primary practice location
510 4TH St S
Fargo, ND 58103
Mailing address
620 Main Ave
310
Fargo, ND 58103
Phone (701) 371-8411
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5085104 | ND | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689766750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 MAIN AVE",
"address_2": "310",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-371-8411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 4TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-476-7200",
"fax_number": "701-476-7273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "LESLIE",
"middle_name": "RAE",
"name_prefix": "Ms.",
"credential": "LPC MS NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ND",
"license": "5085104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.