John Robert Mack, MA, C-QMHP
Individual provider Active NPI Mental Health Counselor · Grants Pass, OR
NPI 1891875993 · NPPES record last updated Jun 18, 2020
Key facts
- NPI
- 1891875993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1215 SW G St
Grants Pass, OR 97526-2544 - Phone
- (541) 476-2373
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1215 SW G St
Grants Pass, OR 97526-2544
Mailing address
1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891875993 | Medicaid | OR |
Other providers in Grants Pass, OR
- Justin Harrison Lyons
- Mathew Lytle
- Catherine Lee Mabbatt
- Elizabeth Anne Mabry
- Jenna Marie Macaluso
- Michelle Jeanne Madigan
- Rosy Isela Madrigal Rodriguez
- Mark Maffett
- Sabina Nicole Magdalen
- Cynthia Marie Mahoney
All providers in Grants Pass, OR · Mental Health Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.