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General NPI Number Information
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NPI Number | 1275492191
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Entity Type | Organization
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Legal Business Name | MALLORY FOUNTAIN, PLLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 8778 LONG LAKE DR E
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City | SCOTTS
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State | MI
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Zip | 49088-8719
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Country | US
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Telephone | 269-370-9074
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Fax |
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Provider Business Mailing Address
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Address Line | 8778 LONG LAKE DR E
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City | SCOTTS
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State | MI
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Zip | 49088-8719
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Country | US
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Telephone | 269-370-9074
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MALLORY FOUNTAIN
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Credential | LMSW
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Telephone | 269-370-9074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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