Provider Demographics
NPI:1609116334
Name:MCMAHON, ANNA AMELIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:AMELIA
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:AMELIA
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:103 KIRVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2401
Mailing Address - Country:US
Mailing Address - Phone:972-921-5555
Mailing Address - Fax:
Practice Address - Street 1:4396 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8948
Practice Address - Country:US
Practice Address - Phone:972-358-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7668101Y00000X
TX66531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66531OtherTEXAS STATE BOARD OF EXAMINERS AND PROFESSIONAL COUNSELORS
LA7668OtherLOUISIANA LPC LICENSURE NUMBER