Healthcare Provider Details

I. General information

NPI: 1437854734
Provider Name (Legal Business Name): MALLORY ANNE HAGLER BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 S BRUNDIDGE ST
TROY AL
36081-3148
US

IV. Provider business mailing address

112 ADRIS PL
DOTHAN AL
36303-1997
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2025-111
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: