Provider Demographics
NPI:1023206679
Name:MALLES, LAURIE (MAED)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:MALLES
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-2316
Mailing Address - Country:US
Mailing Address - Phone:602-841-1136
Mailing Address - Fax:602-973-8416
Practice Address - Street 1:5631 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-2316
Practice Address - Country:US
Practice Address - Phone:602-841-1136
Practice Address - Fax:602-973-8416
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool