| Doctor Name: | ANNE M MALLORY |
| NPI Number: | 1093055626 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, ACADC |
| License Number: | 10118 |
| Business Practice Address: | 2805 Blaine St Suite 120 Caldwell, ID - 836054599 |
| Business Phone Number: | 2084594412 |
| Business Fax Number: | 2084547296 |
| Mailing Address: | 2805 Blaine St, Suite 120 CALDWELL |
| State: | ID |
| Postal Code: | 836054599 |
| Phone Number: | 2084594412 |
| Fax Number: | 2084547296 |
| NPI Enumeration Date: | 02/19/2013 |
| NPI Last Update Date: | 02/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 10118 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |