Provider Demographics
NPI:1447098041
Name:MCMAHON, CRYSTAL (QMHP-R)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 NW EDENBOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6224
Mailing Address - Country:US
Mailing Address - Phone:541-672-8533
Mailing Address - Fax:
Practice Address - Street 1:500 SE CASS AVE STE 110
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3165
Practice Address - Country:US
Practice Address - Phone:541-677-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHP-R-2850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health