Physician Compare National (NPI:1730634072)
HEALTHCARE PROVIDER: MICHAEL MAHAN LCSW, LCDC
Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.
Individual Professional Information |
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NPI
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1730634072
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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1456631829
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20161201001742
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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MAHAN
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Individual professional last name
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Provider First Name
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MICHAEL
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Individual professional first name
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Provider Gender
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M
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The provider's gender if the provider is a person.
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Medical School Information |
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Medical School Name
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OTHER
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Individual professional's medical school
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Graduation Year
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2011
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Individual professional's medical school graduation year
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Primary Specialty
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CLINICAL SOCIAL WORKER
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Primary medical specialty reported by the individual professional in the selected enrollment
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Practice Information |
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Line 1 Street Address
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4833 SPICEWOOD SPRINGS RD
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Group Practice or individual's line 1 address
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Line 2 Street Address
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SUITE 100
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Group Practice or individual's line 2 address
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City
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AUSTIN
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Group Practice or individual's city
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State
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TX
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Group Practice or individual's state
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Zip Code
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787598436
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Group Practice or individual's zip code (9 digits when available)
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Phone Number
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5123421718
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Phone number is listed only when there is a single phone number available for the practice location address
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Hospital(s) Affiliation Information |
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Professional Accepts Medicare Assignment
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Y
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