Individual
MARK B MAHACEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
19100 N FRUITPORT RD, SPRING LAKE, MI 49456-1165
(616) 842-2125
Mailing address
19100 N FRUITPORT RD, SPRING LAKE, MI 49456-1165
(616) 842-2125
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MM008350
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680G035200
BCBSM
MI
Enumeration date
10/13/2006
Last updated
10/05/2023
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