MEDICARE: ENRICA GONZALEZ MALONE MFT

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	106H00000X	Marriage & Family Therapist	52951	CA
2	106H00000X	Marriage & Family Therapist	202494	TX

General Provider Information

NPI Number	:	1619226222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRICA GONZALEZ MALONE MFT

Provider Business Mailing Address
First Line	:	25511 BUDDE RD STE 1502
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77380-2081
Country	:	US
Telephone Number	:	619-804-1176
Fax Number	:

Provider Business Practice Location Address
First Line	:	25511 BUDDE RD
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-2080
Country	:	US
Telephone Number	:	936-828-4080
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	09/27/2023

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