Provider Demographics
NPI:1346631926
Name:MAHIN, SIRLIVIA BELL DEMORNA (MRC, CRC, LPCA)
Entity Type:Individual
Prefix:MRS
First Name:SIRLIVIA
Middle Name:BELL DEMORNA
Last Name:MAHIN
Suffix:
Gender:F
Credentials:MRC, CRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 CABINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2607
Mailing Address - Country:US
Mailing Address - Phone:502-802-8220
Mailing Address - Fax:
Practice Address - Street 1:3207 CABINWOOD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2607
Practice Address - Country:US
Practice Address - Phone:502-802-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA0019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health