Individual
SHEA MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
1500 S AVENUE K, PORTALES, NM 88130
(575) 562-2156
Mailing address
3725 TOM WATSON DR, CLOVIS, NM 88101-3155
(575) 309-1606
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/14/2017
Last updated
05/17/2018
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