Healthcare Provider Details

I. General information

NPI: 1609900471
Provider Name (Legal Business Name): DAVID JOSEPH MAHONEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND ST E
WHITEFISH MT
59937-2410
US

IV. Provider business mailing address

100 2ND ST E
WHITEFISH MT
59937-2410
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-1731
  • Fax:
Mailing address:
  • Phone: 406-257-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMT # 378
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberKY367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: