Provider Demographics
NPI:1215227947
Name:MCMAHAN, RICHARD COLLINS (MA, CACIII)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:COLLINS
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:MA, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2927
Mailing Address - Country:US
Mailing Address - Phone:970-302-5204
Mailing Address - Fax:
Practice Address - Street 1:6127 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2927
Practice Address - Country:US
Practice Address - Phone:970-302-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2040101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)