Provider Demographics
NPI:1760367825
Name:MAHAN, CORIE SUE
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:SUE
Last Name:MAHAN
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:AM MELONENBERG 8
Mailing Address - Street 2:
Mailing Address - City:WIESBADEN
Mailing Address - State:HESSEN
Mailing Address - Zip Code:65187
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SONNENBERGER STR. 64
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:HESSEN
Practice Address - Zip Code:65187
Practice Address - Country:DE
Practice Address - Phone:572-290-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-82277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst