Provider Demographics
NPI:1467494922
Name:MOHAN, ALLISON (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 STANBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3609 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1709
Practice Address - Country:US
Practice Address - Phone:503-314-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20642103TC0700X
OR2542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500685096Medicaid
CAPSY206420Medicaid
CAPSY206420Medicaid