1215128384 NPI number — TINA M MALUNAY LPC

Table of content: TINA M MALUNAY LPC (NPI 1215128384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215128384 NPI number — TINA M MALUNAY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALUNAY
Provider First Name:
TINA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORVATH
Provider Other First Name:
TINA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215128384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 BOILING SPRINGS ROAD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29303-2236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-754-4018
Provider Business Mailing Address Fax Number:
864-754-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 BOILING SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-754-4018
Provider Business Practice Location Address Fax Number:
864-754-4022
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  5031 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 4620 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC1691 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3335 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 121328 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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