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General NPI Number Information
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NPI Number | 1134701469
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Entity Type | Individual
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Provider Name | MALLORY W GAKPO
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 501 S 9TH ST STE 108
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City | NOBLESVILLE
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State | IN
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Zip | 46060-2709
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Country | US
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Telephone | 317-333-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 4925 DUNLIN DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-0014
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Country | US
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Telephone | 317-694-9702
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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 | 33008825A
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License Number State | IN
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