Healthcare Provider Details

I. General information

NPI: 1609785534
Provider Name (Legal Business Name): MCMAHON MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N ORCHARD AVE
CANON CITY CO
81212-2540
US

IV. Provider business mailing address

PO BOX 183
CANON CITY CO
81215-0183
US

V. Phone/Fax

Practice location:
  • Phone: 719-409-7014
  • Fax: 719-966-8672
Mailing address:
  • Phone: 719-409-7014
  • Fax: 719-966-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN M MCMAHON
Title or Position: OWNER
Credential: NP
Phone: 719-409-7014