MEDICARE: BRIAN JAMES MCMAHON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	112178	CA

General Provider Information

NPI Number	:	1205395928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JAMES MCMAHON LMFT

Provider Business Mailing Address
First Line	:	2942 WABASH AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-2170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2942 WABASH AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-2170
Country	:	US
Telephone Number	:	503-816-9435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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