Provider Demographics
NPI:1255463303
Name:MAHON, LISA MARKS
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARKS
Last Name:MAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMHC
Mailing Address - Street 1:P.O. BOX 1001
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0008
Mailing Address - Country:US
Mailing Address - Phone:360-385-7760
Mailing Address - Fax:360-385-6387
Practice Address - Street 1:826 ADAMS ST.
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5506
Practice Address - Country:US
Practice Address - Phone:360-385-7760
Practice Address - Fax:360-385-6387
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health