Individual
JILLIAN LISA MARIE MAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-R, CRM
Contact information
Practice address
534 E MAIN ST, MEDFORD, OR 97504-7118
(541) 200-1530
(541) 772-0284
Mailing address
534 E MAIN ST, MEDFORD, OR 97504-7118
(541) 200-1530
(541) 772-0284
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000104724
TRADITIONAL HEALTH WORKER, PEER SUPPORT SPECIALIST
OR
Enumeration date
12/12/2022
Last updated
02/13/2023
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