Provider Demographics
NPI:1679950265
Name:MAHONY, CATHLEEN M (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:MAHONY
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:MAHONY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, CADC
Mailing Address - Street 1:1934 OZARK PKWY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5436
Mailing Address - Country:US
Mailing Address - Phone:815-527-1952
Mailing Address - Fax:
Practice Address - Street 1:9113 TRINITY DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1668
Practice Address - Country:US
Practice Address - Phone:815-527-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009574101Y00000X, 101YM0800X
IL30204101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health