Healthcare Provider Details

I. General information

NPI: 1265611743
Provider Name (Legal Business Name): BETHANN MAHONEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 N ORACLE RD SUITE 100
TUCSON AZ
85704-4246
US

IV. Provider business mailing address

6812 N ORACLE RD SUITE 100
TUCSON AZ
85704-4246
US

V. Phone/Fax

Practice location:
  • Phone: 520-797-3077
  • Fax: 520-742-0050
Mailing address:
  • Phone: 520-797-3077
  • Fax: 520-742-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3436
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number3436
License Number StateAZ

VIII. Authorized Official

Name: DR. BETHANN MAHONEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 520-797-3077