Provider Demographics
NPI:1063867224
Name:SCHWARTZ, MALLORY (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 TELEGRAPH RD STE 1775
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4593
Mailing Address - Country:US
Mailing Address - Phone:248-421-2898
Mailing Address - Fax:
Practice Address - Street 1:30800 TELEGRAPH RD
Practice Address - Street 2:STE. 1775
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4542
Practice Address - Country:US
Practice Address - Phone:248-629-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health