Healthcare Provider Details

I. General information

NPI: 1588999643
Provider Name (Legal Business Name): MICHAEL E. MAHON PSY.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 OFFICE PKWY
CREVE COEUR MO
63141-7103
US

IV. Provider business mailing address

644 OFFICE PKWY
CREVE COEUR MO
63141-7103
US

V. Phone/Fax

Practice location:
  • Phone: 314-910-0758
  • Fax:
Mailing address:
  • Phone: 314-910-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024023876
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: