Individual
MS. SUELLYN M MAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
1400 E PUGH DR, SUITE 3, TERRE HAUTE, IN 47802-3942
(812) 236-9569
(812) 235-2929
Mailing address
1400 E PUGH DR, SUITE 3, TERRE HAUTE, IN 47802-3942
(812) 236-9569
(812) 235-2929
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
20041149
IN
103TS0200X
School Psychologist
Primary
20041149
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200154190
—
IN
Enumeration date
08/24/2005
Last updated
08/04/2010
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