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General NPI Number Information
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NPI Number | 1831378074
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Entity Type | Individual
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Provider Name | MARJORIE MALONE PHD, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 413 SIPAPU ROAD 6952
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-758-5857
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Fax | 575-758-2832
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Provider Business Mailing Address
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Address Line | PO BOX 2070 209 LAS CRUCES LANE
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City | TAOS
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State | NM
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Zip | 87571-2070
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Country | US
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Telephone | 505-758-1565
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CSAC II 169
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC 96621
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC 96621
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | LPCC 96621
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | LMFT 43969
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 43969
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0096621
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License Number State | NM
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