Provider Demographics
NPI:1427701515
Name:MCMAHON THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:MCMAHON THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,MSW,LISW
Authorized Official - Phone:515-421-6728
Mailing Address - Street 1:1200 VALLEY WEST DR, SUITE 206-10
Mailing Address - Street 2:MARYPATMCMAHON@YAHOO.COM
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-421-6728
Mailing Address - Fax:
Practice Address - Street 1:1200 VALLEY WEST DR STE 206-10
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1938
Practice Address - Country:US
Practice Address - Phone:515-421-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA090929OtherSTATE LICENSING NUMBER