Healthcare Provider Details

I. General information

NPI: 1801542741
Provider Name (Legal Business Name): PATRICIA LYNN MAHANAY PSYCHIATRIC TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 FORNI RD
PLACERVILLE CA
95667-7013
US

IV. Provider business mailing address

700 BUSTER CHATHAM RD STE 36
WACO TX
76705-5473
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone: 305-250-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: