Provider Demographics
NPI:1659641934
Name:MEREDITH MCMAHON PSYD LLC
Entity Type:Organization
Organization Name:MEREDITH MCMAHON PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CADC, LCPC
Authorized Official - Phone:773-575-6865
Mailing Address - Street 1:2030 E ALGONQUIN RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4188
Mailing Address - Country:US
Mailing Address - Phone:773-575-6865
Mailing Address - Fax:847-925-1355
Practice Address - Street 1:2030 E ALGONQUIN RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4188
Practice Address - Country:US
Practice Address - Phone:773-575-6865
Practice Address - Fax:847-925-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007472251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health