Provider Demographics
NPI:1033656301
Name:HAMM, MALLORY (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 REED DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4548
Mailing Address - Country:US
Mailing Address - Phone:606-392-1057
Mailing Address - Fax:
Practice Address - Street 1:251 DEMOCRAT DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-9214
Practice Address - Country:US
Practice Address - Phone:502-385-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health