Provider Demographics
NPI:1205608981
Name:MAHONEY, ANNA (MED, LSC, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MED, LSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E. COEUR D'ALENE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-699-6817
Mailing Address - Fax:208-620-2306
Practice Address - Street 1:211 E. COEUR D'ALENE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-699-6817
Practice Address - Fax:208-620-2306
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health