Provider Demographics
NPI:1427659648
Name:MAHAN, THOR LAWLER (LPC)
Entity type:Individual
Prefix:
First Name:THOR
Middle Name:LAWLER
Last Name:MAHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARGARET CT
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4825
Mailing Address - Country:US
Mailing Address - Phone:732-691-0604
Mailing Address - Fax:
Practice Address - Street 1:30 MARGARET CT
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4825
Practice Address - Country:US
Practice Address - Phone:732-691-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional