Provider Demographics
NPI:1659017697
Name:MCMAHON, MELISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16669-0175
Mailing Address - Country:US
Mailing Address - Phone:814-599-0931
Mailing Address - Fax:
Practice Address - Street 1:380 KING STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:16669
Practice Address - Country:US
Practice Address - Phone:814-599-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional