Provider Demographics
NPI:1891059143
Name:MCMAHON, TIMOTHY CRAIG (MA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 DORCHESTER DR N APT 206
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3771
Mailing Address - Country:US
Mailing Address - Phone:248-318-6492
Mailing Address - Fax:
Practice Address - Street 1:2427 DORCHESTER DR N APT 206
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3771
Practice Address - Country:US
Practice Address - Phone:248-318-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional