Healthcare Provider Details

I. General information

NPI: 1457801466
Provider Name (Legal Business Name): MONIQUE MAHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 100 YEARPARTY CT STE 200
LONGMONT CO
80504-8591
US

IV. Provider business mailing address

720 100 YEARPARTY CT STE 200
LONGMONT CO
80504-8591
US

V. Phone/Fax

Practice location:
  • Phone: 720-449-6676
  • Fax: 303-374-5224
Mailing address:
  • Phone: 720-449-6676
  • Fax: 303-374-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCG60704005
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCG60704005
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: