Healthcare Provider Details

I. General information

NPI: 1396134177
Provider Name (Legal Business Name): KATIE MALLOY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 11TH AVE
LONGVIEW WA
98632-2555
US

IV. Provider business mailing address

PO BOX 852
VANCOUVER WA
98666-0852
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-8600
  • Fax: 360-636-7372
Mailing address:
  • Phone: 360-869-6094
  • Fax: 360-636-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60777028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: