| Doctor Name: | DR. MALLORY YOUNGHONG MAO |
| NPI Number: | 1467865303 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.D. |
| License Number: | KY 1111 |
| Business Practice Address: | 3326 Pioneer Trl Shepherdsville, KY - 401659203 |
| Business Phone Number: | 5027447422 |
| Business Fax Number: | |
| Mailing Address: | 3326 Pioneer Trl, SHEPHERDSVILLE |
| State: | KY |
| Postal Code: | 401659203 |
| Phone Number: | 5027447422 |
| Fax Number: | |
| NPI Enumeration Date: | 06/09/2014 |
| NPI Last Update Date: | 06/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | KY 1111 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |