Most Relevant Information
Provider Data
| NPI Number: | 1003553595 |
| Provider Name: | TEKEYSHA MACK LMSW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | LMSW-19164 |
Most Important Dates
| Enumeration Date: | 05/16/2022 |
| Last Updated: | 05/16/2022 |
Provider Practice Location
3620 N 3RD ST
PHOENIX
AZ
850122020
Practice Location Phone/Fax
| Phone: | 6022307373 |
| Fax: | 6022578029 |
Provider Mailing Location
3620 N 3RD ST
PHOENIX
AZ
850122020
Provider Mailing Phone/Fax
| Phone: | 6023298250 |
| Fax: |