MEDICARE: MISS ANTOINETTE MALLETT LPC

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	101Y00000X	Counselor	6401014164	MI

General Provider Information

NPI Number	:	1679953491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANTOINETTE MALLETT LPC

Provider Business Mailing Address
First Line	:	4710 W SAGINAW HWY STE 9
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-2654
Country	:	US
Telephone Number	:	517-684-0577
Fax Number	:	517-977-1232

Provider Business Practice Location Address
First Line	:	4710 W SAGINAW HWY STE 9
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-2654
Country	:	US
Telephone Number	:	517-615-8312
Fax Number	:

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

Provider Enumeration Date	:	06/06/2015
Last Update Date	:	12/04/2024

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