Provider Demographics
NPI:1053746248
Name:MAHAN, EDDIE L (LPC)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:L
Last Name:MAHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 E RENFRO ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2205
Mailing Address - Country:US
Mailing Address - Phone:817-995-4623
Mailing Address - Fax:817-295-3768
Practice Address - Street 1:112 SW THOMAS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3818
Practice Address - Country:US
Practice Address - Phone:817-295-4623
Practice Address - Fax:817-295-3768
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional