Provider Demographics
NPI:1942357710
Name:MOLLAHAN, JOHN OWEN (MS, LMHC, CRC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OWEN
Last Name:MOLLAHAN
Suffix:
Gender:M
Credentials:MS, LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4418
Mailing Address - Country:US
Mailing Address - Phone:360-600-9559
Mailing Address - Fax:360-574-5495
Practice Address - Street 1:400 E EVERGREEN BLVD STE 207
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:360-600-9559
Practice Address - Fax:360-574-5495
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008924101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional