MEDICARE: CATHLEEN M. MAHONY LCPC, CADC

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	101Y00000X	Counselor	180009574	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	30204	IL
3	101YM0800X	Mental Health Counselor	180009574	IL

General Provider Information

NPI Number	:	1679950265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLEEN M. MAHONY LCPC, CADC

Provider Business Mailing Address
First Line	:	1934 OZARK PKWY
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-5436
Country	:	US
Telephone Number	:	815-527-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	9113 TRINITY DR
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-1668
Country	:	US
Telephone Number	:	815-527-1952
Fax Number	:

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

Provider Enumeration Date	:	05/03/2015
Last Update Date	:	06/03/2016

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