Provider Demographics
NPI:1841489572
Name:MAHAN AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:MAHAN AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:812-236-9569
Mailing Address - Street 1:1400 E PUGH DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3942
Mailing Address - Country:US
Mailing Address - Phone:812-236-9569
Mailing Address - Fax:812-235-2929
Practice Address - Street 1:2931 OHIO BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2240
Practice Address - Country:US
Practice Address - Phone:812-236-9569
Practice Address - Fax:812-235-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253330Medicare PIN