=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962973198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALORIE KAY OUELLETTE LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2018
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 EAST AVE
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04240-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-577-6040
-----------------------------------------------------
Fax | 207-753-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 BOOTHBY RD
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04253-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-577-6040
-----------------------------------------------------
Fax | 207-753-1999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | XM5146
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF6484
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------