| Michael W Mackie Phd A Professional Corp | |
|
10700 Santa Monica Blvd Ste 300 Los Angeles CA 90025-6587 | |
| (424) 465-2840 | |
| Not Available |
| Full Name | Michael W Mackie Phd A Professional Corp |
|---|---|
| Speciality | Psychologist |
| Location | 10700 Santa Monica Blvd Ste 300, Los Angeles, California |
| Authorized Official Name and Position | Michael William Vincent Mackie (OWNER PROVIDER) |
| Authorized Official Contact | 4244652840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael W Mackie Phd A Professional Corp 10700 Santa Monica Blvd Ste 300 Los Angeles CA 90025-6587 Ph: (424) 465-2840 | Michael W Mackie Phd A Professional Corp 10700 Santa Monica Blvd Ste 300 Los Angeles CA 90025-6587 Ph: (424) 465-2840 |
| NPI Number | 1174385892 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 01/29/2024 |
| Certification Date | 01/28/2024 |
| Medicare PECOS PAC ID | 8820433477 |
|---|---|
| Medicare Enrollment ID | O20240305002290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174385892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TF0200X | Psychologist - Forensic | (* (Not Available)) | Primary |
| Provider Name | Michael William Vincent Mackie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851881379 PECOS PAC ID: 3476807322 Enrollment ID: I20181113002652 |
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