Provider Demographics
NPI:1851778252
Name:MAHAN, PENNY LYNN (MS)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:LYNN
Last Name:MAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:LYNN
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2821 MUSTANG TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6688
Mailing Address - Country:US
Mailing Address - Phone:405-973-6997
Mailing Address - Fax:
Practice Address - Street 1:2821 MUSTANG TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6688
Practice Address - Country:US
Practice Address - Phone:405-973-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health