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General NPI Number Information
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NPI Number | 1811549629
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Entity Type | Individual
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Provider Name | NANCY I MCMAHAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 06/01/2024
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Provider Practice Location Address
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Address Line | 2430 S TITANIUM PL
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City | MERIDIAN
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State | ID
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Zip | 83642-6703
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Country | US
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Telephone | 208-284-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 8813 W DULCIMER ST
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City | BOISE
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State | ID
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Zip | 83709-7858
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Country | US
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Telephone | 208-284-0474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC9364
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | COUI-7203
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License Number State | ID
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