Healthcare Provider Details

I. General information

NPI: 1972258937
Provider Name (Legal Business Name): MALLORY MARLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 S BRUNDIDGE ST
TROY AL
36081-3148
US

IV. Provider business mailing address

211 CHINOOK DR
ENTERPRISE AL
36330-8023
US

V. Phone/Fax

Practice location:
  • Phone: 336-618-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: