Provider Demographics
NPI:1538565528
Name:MAHANA, MICHAEL DON (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DON
Last Name:MAHANA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-434-5285
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:925 OILFIELD AVE STE 2
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-2704
Practice Address - Country:US
Practice Address - Phone:406-434-5285
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT89861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0701863OtherBLUE CROSS-SHIELD OF MONTANA
MT0MT0701863OtherBLUE CROSS-SHIELD OF MONTANA