Provider Demographics
NPI:1376108480
Name:MCMAHAN, JAMEL
Entity Type:Individual
Prefix:
First Name:JAMEL
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41760 IVY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9416
Mailing Address - Country:US
Mailing Address - Phone:951-595-4673
Mailing Address - Fax:951-595-4301
Practice Address - Street 1:1001 S STATE ST STE A
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7188
Practice Address - Country:US
Practice Address - Phone:951-357-6959
Practice Address - Fax:951-356-2115
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician