Provider Demographics
NPI:1245562487
Name:MCMAHAN, SALLY (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 PINECONE LN W APT M
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-2183
Mailing Address - Country:US
Mailing Address - Phone:317-200-1310
Mailing Address - Fax:765-964-4300
Practice Address - Street 1:1649 PINECONE LN W APT M
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-2183
Practice Address - Country:US
Practice Address - Phone:317-200-1310
Practice Address - Fax:765-964-4300
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002272A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical