MEDICARE: NICOLE MIKEL MALONE LMSW

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	104100000X	Social Worker	117491	TX

General Provider Information

NPI Number	:	1699639039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MIKEL MALONE LMSW

Provider Business Mailing Address
First Line	:	10505 S IH 35 APT 1835
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2648
Country	:	US
Telephone Number	:	918-200-8661
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 S IH 35 APT 1835
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2648
Country	:	US
Telephone Number	:	918-200-8661
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/12/2025

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