1760666358 NPI number — MEREDITH ELAINE MCMAHON PSYD, CADC, LCPC

Table of content: MEREDITH ELAINE MCMAHON PSYD, CADC, LCPC (NPI 1760666358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760666358 NPI number — MEREDITH ELAINE MCMAHON PSYD, CADC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMAHON
Provider First Name:
MEREDITH
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD, CADC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760666358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1786 MOON LAKE BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-5029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-755-8090
Provider Business Mailing Address Fax Number:
847-843-7393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1786 MOON LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-755-8090
Provider Business Practice Location Address Fax Number:
847-843-7393
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  180-007472 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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