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NPI Code Detail

MEDICARE: MR. TODD MALLOY MA, LMFT, CST, CSE

MEDICARE: MR. TODD MALLOY MA, LMFT, CST, CSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist8000ANC

General Provider Information

NPI Number : 1184978926
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TODD MALLOY MA, LMFT, CST, CSE
Provider Business Mailing Address
First Line : 13420 REESE BLVD W
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7925
Country : US
Telephone Number : 704-659-2511
Fax Number : 704-659-2424
Provider Business Practice Location Address
First Line : 13420 REESE BLVD W
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7925
Country : US
Telephone Number : 704-659-2511
Fax Number : 704-659-2424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2012
Last Update Date : 10/10/2020

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