Provider Demographics
NPI:1669349171
Name:MAHON, JENNIFER ANASTASIA (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANASTASIA
Last Name:MAHON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 CAUGHLIN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0972
Mailing Address - Country:US
Mailing Address - Phone:320-905-4345
Mailing Address - Fax:507-218-8492
Practice Address - Street 1:4745 CAUGHLIN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0972
Practice Address - Country:US
Practice Address - Phone:320-905-4345
Practice Address - Fax:507-218-8492
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1821518929101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty