1689065344 NPI number — MR. JAMES JOSEPH MALLON MA, LPCC

Table of content: MR. JAMES JOSEPH MALLON MA, LPCC (NPI 1689065344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689065344 NPI number — MR. JAMES JOSEPH MALLON MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALLON
Provider First Name:
JAMES
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689065344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 10TH AVE S
Provider Second Line Business Mailing Address:
SUITE 210/212
Provider Business Mailing Address City Name:
HOPKINS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55343-9402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-296-0152
Provider Business Mailing Address Fax Number:
612-216-5479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 10TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 210/212
Provider Business Practice Location Address City Name:
HOPKINS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-296-0152
Provider Business Practice Location Address Fax Number:
612-216-5479
Provider Enumeration Date:
02/16/2015

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: 101YM0800X , with the licence number:  1149 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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