MEDICARE: KRISTA JOY MALONE MSW

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

General Provider Information

NPI Number	:	1295361384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA JOY MALONE MSW

Provider Business Mailing Address
First Line	:	4155 THUNDERCLOUD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4973
Country	:	US
Telephone Number	:	719-291-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 AUSTIN BLUFFS PKWY STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5758
Country	:	US
Telephone Number	:	719-344-9482
Fax Number	:

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

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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