Provider Demographics
NPI:1871529446
Name:ROUN, MAHLON DAVID JR (DBH, LCSW)
Entity type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:DAVID
Last Name:ROUN
Suffix:JR
Gender:M
Credentials:DBH, LCSW
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:ROUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4977 E BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4711
Mailing Address - Country:US
Mailing Address - Phone:520-390-2986
Mailing Address - Fax:
Practice Address - Street 1:4977 E BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4711
Practice Address - Country:US
Practice Address - Phone:520-390-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-176451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical