Provider Demographics
NPI:1831890854
Name:BRENNA MCMAHON, LMSW, L.L.C.
Entity type:Organization
Organization Name:BRENNA MCMAHON, LMSW, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-862-9502
Mailing Address - Street 1:2018 DEVOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4722
Mailing Address - Country:US
Mailing Address - Phone:616-862-9502
Mailing Address - Fax:
Practice Address - Street 1:2018 DEVOLSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4722
Practice Address - Country:US
Practice Address - Phone:616-862-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health