Kevin Joseph Mack, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 12983 Issued in CA

Practice address

23000 Henderson Road
Covelo, CA 95428-0247

Phone

(707) 983-6648

Fax

(707) 983-6649

NPI assigned

Jul 11, 2006

Last updated

Jul 9, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Round Valley Indian Health Center, Inc.Group PAC ID 9234128927, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Round Valley Indian Health Center, Inc.

  • Clinic/Center
  • Covelo, CA
  • NPI 1669532750
  Medicare reassignment Care Compare group NPD
• Round Valley Indian Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Covelo, CA
  • NPI 1114136066
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1760416903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "COVELO",
            "state": "CA",
            "postal_code": "954280247",
            "telephone_number": "707-983-6648",
            "fax_number": "707-983-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23000 HENDERSON ROAD",
            "city": "COVELO",
            "state": "CA",
            "postal_code": "954280247",
            "telephone_number": "707-983-6648",
            "fax_number": "707-983-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KEVIN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 12983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig B Emerson, DDS
• Rose Margarette Johnson, DENTAL HYGIENIST
• Stephen Archie Johnson, RN, NP ,PA
• Sarah Kagin
• Someth Lor, D.D.S
• Marilyn Sue Magoffin, FNP, CWCN
• Maryann Ruth Molina Brookins, CSAC II, CADC II
• Bradley S Nydegger, D.D.S
• Snehal Raisoni, MD
• Round Valley Indian Health Center

• Clinical Psychologist in Covelo, CA
• Providers in Covelo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; 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.