Individual
KEVYN MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
160 E VIRGINIA ST STE 100, SAN JOSE, CA 95112-5865
(408) 938-2113
(408) 579-6143
Mailing address
160 E VIRGINIA ST STE 100, SAN JOSE, CA 95112-5865
(408) 938-2113
(408) 579-6143
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
APCC21139
CA
225400000X
Rehabilitation Practitioner
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2024
Last updated
11/04/2025
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