Provider Demographics
NPI:1447845235
Name:MACE, ROBERT H (MA, LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:MACE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-5297
Mailing Address - Country:US
Mailing Address - Phone:325-728-0732
Mailing Address - Fax:
Practice Address - Street 1:461 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653-5297
Practice Address - Country:US
Practice Address - Phone:325-728-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional