Provider Demographics
NPI:1760882807
Name:MCMAHAN, JANET MARIE
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARIE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:53479 CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-2371
Mailing Address - Country:US
Mailing Address - Phone:918-942-8721
Mailing Address - Fax:
Practice Address - Street 1:53479 CUT OFF RD
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2371
Practice Address - Country:US
Practice Address - Phone:918-942-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling