Provider Demographics
NPI:1427447812
Name:MCMAHAN COUNSELING
Entity type:Organization
Organization Name:MCMAHAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:AJ
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-366-0282
Mailing Address - Street 1:14206 CLARBORNE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5589
Mailing Address - Country:US
Mailing Address - Phone:501-366-0282
Mailing Address - Fax:501-712-1385
Practice Address - Street 1:2200 N RODNEY PARHAM RD
Practice Address - Street 2:210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4140
Practice Address - Country:US
Practice Address - Phone:501-366-0282
Practice Address - Fax:501-712-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0107024251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204391719Medicaid