Provider Demographics
NPI:1285955484
Name:MCMAHON, MELINDA GRAY (PHD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:GRAY
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:GRAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3911
Mailing Address - Country:US
Mailing Address - Phone:720-299-5897
Mailing Address - Fax:
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3911
Practice Address - Country:US
Practice Address - Phone:720-299-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical