Provider Demographics
NPI:1790852754
Name:MCMAHON, MARIE KATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:KATHERINE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD
Mailing Address - Street 2:SUITE #311
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660
Mailing Address - Country:US
Mailing Address - Phone:360-686-9594
Mailing Address - Fax:360-906-7111
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:SUITE #311
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-686-9594
Practice Address - Fax:360-906-7111
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1636103T00000X
WAPY00003105103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7133002Medicaid