Healthcare Provider Details

I. General information

NPI: 1871034199
Provider Name (Legal Business Name): MARQUIN LYNN MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
DURANT OK
74701-5038
US

IV. Provider business mailing address

619 KERBY DR
DENISON TX
75020-4060
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-7330
  • Fax: 580-924-2739
Mailing address:
  • Phone: 903-815-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: