Thomas Criswell Mack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

094424 Issued in IA

Practice address

2710 North Dodge St.
Ste #1
Iowa City, IA 52245

Phone

(319) 400-1311

Fax

(319) 575-6025

NPI assigned

May 26, 2019

Last updated

Feb 10, 2021By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1558828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1881251783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 NORTH DODGE ST.",
            "address_2": "STE #1",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "52245",
            "telephone_number": "319-400-1311",
            "fax_number": "319-575-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 NORTH DODGE ST.",
            "address_2": "STE #1",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "52245",
            "telephone_number": "319-400-1311",
            "fax_number": "319-575-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "THOMAS",
        "middle_name": "CRISWELL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-26",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "094424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camilla Machado Feitosa de Al
• Ann M Machlab, MD
• Shantel Renae Macias, MSN, RN
• Fernando Maciel Barbosa, MD
• Danielle Lee Mack, MD
• Josiah Anthony Mackay
• Ryan Patrick Mackay, MD,PHD
• Noah Mackin, RBT
• Sujana Madathil, M.D.
• Miranda K Maday, LMSW

• Clinical Psychologist in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Clinical Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.