Individual
PAUL JEFFREY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CHTP, ED.D, MS, BA
Contact information
Practice address
1015 MCCAUSLAND AVE, SAINT LOUIS, MO 63117-1924
(314) 781-5050
Mailing address
2960 MILTON BLVD, SAINT LOUIS, MO 63104-1636
(314) 497-5247
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2504
CO
Other
Enumeration date
12/28/2006
Last updated
07/08/2007
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