Provider Demographics
NPI:1780007187
Name:MCMAHAN, AHMED 'AJ' (LPC)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:'AJ'
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11523 KANIS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3724
Mailing Address - Country:US
Mailing Address - Phone:501-366-0282
Mailing Address - Fax:501-712-1385
Practice Address - Street 1:11523 KANIS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3724
Practice Address - Country:US
Practice Address - Phone:501-366-0282
Practice Address - Fax:501-712-1385
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0107024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204391719Medicaid