Provider Demographics
NPI:1356127153
Name:MCMAHAN, LESLIE N (RBT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:N
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MCGEE LOOP
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8404
Mailing Address - Country:US
Mailing Address - Phone:731-431-2145
Mailing Address - Fax:
Practice Address - Street 1:1710 GENERAL GEORGE PATTON DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2904
Practice Address - Country:US
Practice Address - Phone:615-288-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-278851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician