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NPI Code Detail

MEDICARE: MARLENE MICHELLE MAHON

MEDICARE: MARLENE MICHELLE MAHON
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health CounselorIL

General Provider Information

NPI Number : 1508688904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLENE MICHELLE MAHON
Provider Business Mailing Address
First Line : 4429 N WINCHESTER AVE APT 3B
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5847
Country : US
Telephone Number : 206-390-6384
Fax Number :
Provider Business Practice Location Address
First Line : 1811 W NORTH AVE STE 402
Second Line :
City : CHICAGO
State : IL
Zip : 60622-0204
Country : US
Telephone Number : 206-390-6384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2024
Last Update Date : 10/28/2024

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Directions to “ MARLENE MICHELLE MAHON ” Practice Location

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