MEDICARE: DR. CHRISTINE MARIE MALONE PH.D.

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	103TC1900X	Counseling Psychologist	34-557	MS
2	103TC1900X	Counseling Psychologist	P1962	TN

General Provider Information

NPI Number	:	1619923166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE MARIE MALONE PH.D.

Provider Business Mailing Address
First Line	:	11585 CHARLESBASS CV
Second Line	:
City	:	EADS
State	:	TN
Zip	:	38028-6919
Country	:	US
Telephone Number	:	901-867-7480
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 GREEN TREE CV STE 101A
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2551
Country	:	US
Telephone Number	:	901-619-7173
Fax Number	:	901-754-9279

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/22/2021

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