Provider Demographics
NPI:1194304485
Name:MCMAHON, LORI LEE (LAC AND MFT-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LAC AND MFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7161 E 60TH WAY
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-4120
Mailing Address - Country:US
Mailing Address - Phone:720-534-5941
Mailing Address - Fax:
Practice Address - Street 1:14221 E 4TH AVE STE 2-226
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8735
Practice Address - Country:US
Practice Address - Phone:720-534-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001644101YA0400X
COMFTC.0013889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty