Provider Demographics
NPI:1578680484
Name:MCMAHON, JACQUELINE A (BA- CATC #030760)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:BA- CATC #030760
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BUSINESS CENTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1184
Mailing Address - Country:US
Mailing Address - Phone:805-375-9100
Mailing Address - Fax:805-375-9920
Practice Address - Street 1:1125 BUSINESS CENTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1184
Practice Address - Country:US
Practice Address - Phone:805-375-9100
Practice Address - Fax:805-375-9920
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC #030760101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health