Healthcare Provider Details

I. General information

NPI: 1740258524
Provider Name (Legal Business Name): JOHN J. MALONEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 E KINGSLEY ST STE B
SPRINGFIELD MO
65804-7222
US

IV. Provider business mailing address

1358 E KINGSLEY ST STE B
SPRINGFIELD MO
65804-7222
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-1580
  • Fax: 417-881-7004
Mailing address:
  • Phone: 417-887-4245
  • Fax: 417-881-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY01215
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: