MEDICARE: MICHAEL T. MCMAHON MA, LLP, LPC

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	103TC1900X	Counseling Psychologist	6361004487	MI
2	101YP2500X	Professional Counselor	6401008698	MI

General Provider Information

NPI Number	:	1457545162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T. MCMAHON MA, LLP, LPC

Provider Business Mailing Address
First Line	:	PO BOX 1252
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49422-1252
Country	:	US
Telephone Number	:	616-448-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 N WELLNESS DR STE 50
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-805-3660
Fax Number	:	616-805-3631

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	08/23/2022

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