Provider Demographics
NPI:1811188311
Name:MCMAHON, KELLEY JORDAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:JORDAN
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 E PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5513
Mailing Address - Country:US
Mailing Address - Phone:602-391-5850
Mailing Address - Fax:
Practice Address - Street 1:7320 N DREAMY DRAW DR STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-0002
Practice Address - Country:US
Practice Address - Phone:602-391-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ185451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical