Provider Demographics
NPI:1003913393
Name:MCMAHON, ELAINE GRACE (MFT)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:GRACE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1084
Mailing Address - Country:US
Mailing Address - Phone:415-299-2376
Mailing Address - Fax:
Practice Address - Street 1:15 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2924
Practice Address - Country:US
Practice Address - Phone:415-299-2376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT37791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist