Provider Demographics
NPI:1205136231
Name:MAHLEN, JASON LEE (PSY D)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:MAHLEN
Suffix:
Gender:M
Credentials:PSY D
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18315 CASCADE DR.
Mailing Address - Street 2:STE: 165
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347
Mailing Address - Country:US
Mailing Address - Phone:612-695-0071
Mailing Address - Fax:952-767-5087
Practice Address - Street 1:18315 CASCADE DR
Practice Address - Street 2:STE: 165
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1180
Practice Address - Country:US
Practice Address - Phone:612-695-0071
Practice Address - Fax:952-767-5087
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical