Healthcare Provider Details

I. General information

NPI: 1033830237
Provider Name (Legal Business Name): ARTHUR MALLORY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 HALCYON POINTE DR
MONTGOMERY AL
36117-8053
US

IV. Provider business mailing address

208 SETTER TRL
PIKE ROAD AL
36064-4905
US

V. Phone/Fax

Practice location:
  • Phone: 334-954-6010
  • Fax: 334-649-6399
Mailing address:
  • Phone: 334-220-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5126C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: