Provider Demographics
NPI:1083929327
Name:DR MARGOT GAY MAHAN & ASSOC PC
Entity Type:Organization
Organization Name:DR MARGOT GAY MAHAN & ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-719-1360
Mailing Address - Street 1:1555 NAPERVILLE WHEATON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1557
Mailing Address - Country:US
Mailing Address - Phone:312-719-1360
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:1555 NAPERVILLE WHEATON RD
Practice Address - Street 2:SUITE 115
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1557
Practice Address - Country:US
Practice Address - Phone:312-719-1360
Practice Address - Fax:773-751-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4098289017OtherBC/BS