Healthcare Provider Details

I. General information

NPI: 1811824675
Provider Name (Legal Business Name): JACLYN MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E. TUNNEL ST.
SANTA MARIA CA
93454
US

IV. Provider business mailing address

412 E. TUNNEL ST.
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-0315
  • Fax: 866-594-7933
Mailing address:
  • Phone: 805-925-0315
  • Fax: 866-594-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: