MEDICARE: MR. GREGORY S MALONE MA LMHC

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	LH00009767	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LH00009767	OTHER	WA	STATE MENTAL HEALTH LICEN

General Provider Information

NPI Number	:	1407988421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY S MALONE MA LMHC

Provider Business Mailing Address
First Line	:	2136 8TH AVE W
Second Line	:	7
City	:	SEATTLE
State	:	WA
Zip	:	98119-2863
Country	:	US
Telephone Number	:	206-588-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 8TH AVE W
Second Line	:	7
City	:	SEATTLE
State	:	WA
Zip	:	98119-2863
Country	:	US
Telephone Number	:	206-588-6604
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	11/28/2014

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