MARY LYNNE MACK PHD LLC
NPI 1639415078
Psychologist - Clinical in Phoenix, AZ

Q: What is Mary Lynne Mack Phd LLC's NPI number?

The NPI number for Mary Lynne Mack Phd LLC is 1639415078. It was assigned to this organization in the NPPES registry on December 12, 2012.

Q: What is Mary Lynne Mack Phd LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since December 12, 2012

4600 E WASHINGTON ST STE 300, PHOENIX, AZ 85034(480) 737-6076 Get Directions Write a Review

NPPES record last updated: January 9, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 9, 2026, Nov 15, 2019 (2 updates tracked since 2019).

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About Mary Lynne Mack Phd Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY LYNNE MACK PHD LLC (NPI 1639415078) is a healthcare organization registered as a clinical in Phoenix, Arizona and active in the NPI registry since December 2012. The organization lists Mary Lynne Mack, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1639415078

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameMARY LYNNE MACK PHD LLC

Location Address4600 E WASHINGTON ST STE 300Phoenix, AZ 85034-1908

Mailing Address4600 E Washington St Ste 300Phoenix, AZ 85034-1908 · (480) 737-6076

Phone(480) 737-6076

Organization SubpartNo

Authorized OfficialMary Lynne MackPsychologist · (262) 391-2551

Enumeration DateDecember 12, 2012

Last NPPES UpdateJanuary 9, 20262 updates tracked since enumeration

NPPES CertifiedJanuary 9, 2026

✔ NPI 1639415078 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in WI · 2598-057

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

4600 E WASHINGTON ST STE 300, Phoenix, AZ 85034

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary Lynne Mack Phd Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Mary Lynne Mack Phd LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Mary Mack, PHD

Clinical Psychologist

NPI 1700811015

5635 N SCOTTSDALE RD STE 170
Scottsdale, AZ 85250

(480) 737-6076

✔ PECOS5.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Lynne Mack Phd LLC's NPI number?

The NPI number for Mary Lynne Mack Phd LLC is 1639415078. It was assigned to this organization in the NPPES registry on December 12, 2012.

Where is Mary Lynne Mack Phd LLC located?

Mary Lynne Mack Phd LLC is located at 4600 E Washington St Ste 300, Phoenix, AZ 85034. The listed phone number is (480) 737-6076.

What is Mary Lynne Mack Phd LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Mary Lynne Mack Phd LLC enrolled in Medicare?

Yes. Mary Lynne Mack Phd LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mary Lynne Mack Phd LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Mary Lynne Mack Phd LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mary Lynne Mack Phd LLC was last updated on January 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.