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General NPI Number Information
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NPI Number | 1033830237
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Entity Type | Individual
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Provider Name | ARTHUR MALLORY LICSW
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Gender | Male
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 7475 HALCYON POINTE DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-8053
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Country | US
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Telephone | 334-954-6010
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Fax | 334-649-6399
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Provider Business Mailing Address
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Address Line | 208 SETTER TRL
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City | PIKE ROAD
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State | AL
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Zip | 36064-4905
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Country | US
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Telephone | 334-220-8762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5126C
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License Number State | AL
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