Healthcare Provider Details

I. General information

NPI: 1457545162
Provider Name (Legal Business Name): MICHAEL T. MCMAHON MA, LLP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 N WELLNESS DR STE 50
HOLLAND MI
49424-8121
US

IV. Provider business mailing address

PO BOX 1252
HOLLAND MI
49422-1252
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax: 616-805-3631
Mailing address:
  • Phone: 616-448-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361004487
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: