Active NPI
Donna Jo Mahan, LPCC, CADC
- Professional Counselor
- Corbin, KY
National Provider Identifier
1093148884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0626
- Practice address
- 1 Trillium Way
Corbin, KY 40701-8727 - Phone
- (606) 523-8779
- NPI assigned
- Aug 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Professional Counselor | 101YP2500X | 0626 | KY | Primary |
Addresses
Primary practice location
1 Trillium Way
Corbin, KY 40701-8727
Mailing address
PO Box 1325
Corbin, KY 40702-1325
Phone (606) 526-8131
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100282390 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0626 | KY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426032000000",
"number": "1093148884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1325",
"city": "CORBIN",
"state": "KY",
"postal_code": "407021325",
"telephone_number": "606-526-8131",
"fax_number": "606-528-8661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TRILLIUM WAY",
"city": "CORBIN",
"state": "KY",
"postal_code": "407018727",
"telephone_number": "606-523-8779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHAN",
"first_name": "DONNA",
"middle_name": "JO",
"credential": "LPCC, CADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-15",
"last_updated": "2015-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "0626",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100282390",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corbin, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.