MEDICARE: ANDREA NICOLE MAHAN BT

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	106S00000X	Behavior Technician		AZ

General Provider Information

NPI Number	:	1699620815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NICOLE MAHAN BT

Provider Business Mailing Address
First Line	:	9631 E THUNDERBOLT AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-6442
Country	:	US
Telephone Number	:	480-740-6034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 S COUNTRY CLUB DR STE 38
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6886
Country	:	US
Telephone Number	:	619-795-9925
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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