Provider Demographics
NPI:1508922147
Name:MAHAN, THOMAS A (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:MAHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S WEBSTER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5390
Mailing Address - Country:US
Mailing Address - Phone:630-913-1627
Mailing Address - Fax:866-850-1154
Practice Address - Street 1:124 S WEBSTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5390
Practice Address - Country:US
Practice Address - Phone:630-913-1627
Practice Address - Fax:866-850-1154
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist