MEDICARE: MELODIE LYNN MALONE

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
1	101YM0800X	Mental Health Counselor	93873	TX
2	101YP2500X	Professional Counselor	93873	TX

General Provider Information

NPI Number	:	1265316061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODIE LYNN MALONE

Provider Business Mailing Address
First Line	:	4683 PINE GROVE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-4023
Country	:	US
Telephone Number	:	817-680-2251
Fax Number	:

Provider Business Practice Location Address
First Line	:	4683 PINE GROVE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-4023
Country	:	US
Telephone Number	:	817-680-2251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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