MEDICARE: CECILY ELIZABETH MALLOU

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568390136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILY ELIZABETH MALLOU

Provider Business Mailing Address
First Line	:	8500 HARWOOD RD APT 3921
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-0327
Country	:	US
Telephone Number	:	817-876-5617
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 HARWOOD RD APT 3921
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-0327
Country	:	US
Telephone Number	:	817-876-5617
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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