Provider Demographics
NPI:1396572822
Name:MACPHERSON, ILY MADISON
Entity type:Individual
Prefix:
First Name:ILY
Middle Name:MADISON
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 E SAND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-1227
Mailing Address - Country:US
Mailing Address - Phone:949-573-2489
Mailing Address - Fax:
Practice Address - Street 1:2228 E SAND CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-1227
Practice Address - Country:US
Practice Address - Phone:949-573-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional