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General NPI Number Information
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NPI Number | 1396881843
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Entity Type | Individual
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Provider Name | MICHAEL DAVID MALLOY LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7101 EXECUTIVE CENTER DR BLDG 5 SUITE 290
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City | BRENTWOOD
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State | TN
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Zip | 37027-5236
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Country | US
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Telephone | 615-376-6411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3574
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City | BRENTWOOD
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State | TN
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Zip | 37024-3574
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Country | US
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Telephone | 615-376-6411
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW 3136
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License Number State | TN
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