Provider Demographics
NPI:1912540204
Name:MAHN, PAMELA KIM (LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KIM
Last Name:MAHN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:THOMPSON
Other - Last Name:MAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:15708 VAL CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1799
Mailing Address - Country:US
Mailing Address - Phone:405-850-7869
Mailing Address - Fax:
Practice Address - Street 1:15708 VAL CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1799
Practice Address - Country:US
Practice Address - Phone:405-850-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist