Healthcare Provider Details

I. General information

NPI: 1720580921
Provider Name (Legal Business Name): KATIE MARIE MALLINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD BLDG 10
MURFREESBORO TN
37129-1392
US

IV. Provider business mailing address

3400 LEBANON RD BLDG 10
MURFREESBORO TN
37129-1392
US

V. Phone/Fax

Practice location:
  • Phone: 615-630-0648
  • Fax:
Mailing address:
  • Phone: 615-630-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028468
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8762
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: