MEDICARE: MRS. KATHRYN LEIGH MAHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA0103	NV

General Provider Information

NPI Number	:	1063621779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN LEIGH MAHAN

Provider Business Mailing Address
First Line	:	21600 OXNARD ST
Second Line	:	SUITE 1800
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	818-758-8015

Provider Business Practice Location Address
First Line	:	3850 W ANN RD STE 120
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4407
Country	:	US
Telephone Number	:	702-323-6555
Fax Number	:	702-323-6613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	06/27/2019

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