Individual
MR. MARK TACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW, ADC
Contact information
Practice address
7424 APENNINES DR, ARMY SUBSTANCE ABUSE PROGRAM (ASAP), FORT RILEY, KS 66442-7151
(785) 239-0662
Mailing address
7424 APENNINES DR, ARMY SUBSTANCE ABUSE PROGRAM (ASAP), FORT RILEY, KS 66442-7151
(785) 239-0662
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9430
KS
104100000X
Social Worker
Primary
ISW 8702
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9430
LICENSED MASTER SOCIAL WORKER
KS
01
—
ISW 8702
REGISTERED CLINICAL SOCIAL WORKER INTERN
FL
Enumeration date
02/17/2016
Last updated
02/17/2016
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