MEDICARE: DR. MICHAEL E. MAHON PSY.D., 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	101YP2500X	Professional Counselor	2024023876	MO

General Provider Information

NPI Number	:	1588999643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. MAHON PSY.D., LPC

Provider Business Mailing Address
First Line	:	3636 S GEYER RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1237
Country	:	US
Telephone Number	:	314-910-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 S GEYER RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1237
Country	:	US
Telephone Number	:	314-910-0758
Fax Number	:

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	07/10/2024

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