Healthcare Provider Details

I. General information

NPI: 1497501605
Provider Name (Legal Business Name): LONI MALONE MA LPCC LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LONI RUTHERFORD

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 ORCHARD AVE
SAINT PAUL MN
55103-1337
US

IV. Provider business mailing address

805 ORCHARD AVE
SAINT PAUL MN
55103-1337
US

V. Phone/Fax

Practice location:
  • Phone: 612-504-0373
  • Fax:
Mailing address:
  • Phone: 612-504-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5739
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306963
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: