Provider Demographics
NPI:1730944968
Name:MAHON, MICHAEL (PLPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAHON
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RED BUD DR
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1357
Mailing Address - Country:US
Mailing Address - Phone:618-975-7806
Mailing Address - Fax:
Practice Address - Street 1:8000 BONHOMME AVE STE 206
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3515
Practice Address - Country:US
Practice Address - Phone:833-822-5537
Practice Address - Fax:949-863-5179
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003594101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor