Jacob John Mahon, PHD; BCBA-D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3067 Issued in OR

Practice address

1744 E McAndrews Rd Ste B
Medford, OR 97504-5576

Phone

(541) 654-1776

NPI assigned

Jan 6, 2009

Last updated

Aug 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1912143306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 E MCANDREWS RD STE B",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045576",
            "telephone_number": "541-776-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1744 E MCANDREWS RD STE B",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045576",
            "telephone_number": "541-654-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHON",
        "first_name": "JACOB",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PHD; BCBA-D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-06",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "OR",
            "license": "3067",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Madsen, RN
• Michelle Maestro, QMHA
• Valerie Magarian, NP
• Vipul Mahajan, M.D
• John Maurice Mahan, M.D.
• Jillian Lisa Marie Mahon, CADC-R, CRM
• Lexington Mainard, CRM
• Maisha Optical LLC (Advanced Vision Wellness Center)
• Kathryn Maitas, M.A., LPC
• Amanda Rae Maitland

• Clinical Psychologist in Medford, OR
• Providers in Medford, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.