Provider Demographics
NPI:1497175368
Name:MCMAHAN, JEANNIE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 N SANTA FE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9118
Mailing Address - Country:US
Mailing Address - Phone:918-623-8121
Mailing Address - Fax:
Practice Address - Street 1:6402 N SANTA FE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9118
Practice Address - Country:US
Practice Address - Phone:918-623-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health