Provider Demographics
NPI:1811549629
Name:MCMAHAN, NANCY I
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:I
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 W RIFLEMAN ST APT C102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8397
Mailing Address - Country:US
Mailing Address - Phone:208-284-0474
Mailing Address - Fax:
Practice Address - Street 1:740 E WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6420
Practice Address - Country:US
Practice Address - Phone:208-343-7813
Practice Address - Fax:208-342-8268
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-7203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health