Provider Demographics
NPI:1164976114
Name:MAHAL, DEVONA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:DEVONA
Middle Name:MARIE
Last Name:MAHAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W IRONWOOD DR STE 216
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1406
Mailing Address - Country:US
Mailing Address - Phone:208-691-1365
Mailing Address - Fax:
Practice Address - Street 1:101 W IRONWOOD DR STE 216
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1406
Practice Address - Country:US
Practice Address - Phone:208-691-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist