Doctor Name: | SALLY MALLERY |
NPI Number: | 1043257272 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH1962 |
Business Practice Address: | 5315 Trouble Creek Rd New Port Richey, FL - 346524949 |
Business Phone Number: | 7278495588 |
Business Fax Number: | 7278495527 |
Mailing Address: | 1500 Sunset Rd, F5 TARPON SPRINGS |
State: | FL |
Postal Code: | 346892767 |
Phone Number: | 7279438600 |
Fax Number: | |
NPI Enumeration Date: | 05/31/2006 |
NPI Last Update Date: | 09/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH1962 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |