Healthcare Provider Details

I. General information

NPI: 1992272942
Provider Name (Legal Business Name): MALONEY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 RIDGEWAY DR STE 121
LAFAYETTE LA
70503-3410
US

IV. Provider business mailing address

154 VITAL ST
LAFAYETTE LA
70506-5460
US

V. Phone/Fax

Practice location:
  • Phone: 504-722-7932
  • Fax: 337-443-2890
Mailing address:
  • Phone: 504-722-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARTIN MALONEY
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 504-722-7932