Provider Demographics
NPI:1053684225
Name:MALONE, NICHOLAS (MA MFT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MALONE
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 HUMBOLDT RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9196
Mailing Address - Country:US
Mailing Address - Phone:530-896-9577
Mailing Address - Fax:530-894-7066
Practice Address - Street 1:1530 HUMBOLDT RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9196
Practice Address - Country:US
Practice Address - Phone:530-896-9577
Practice Address - Fax:530-894-7066
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist