Provider Demographics
NPI:1134664105
Name:MALONE, TAISH (LPC)
Entity Type:Individual
Prefix:
First Name:TAISH
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:340
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:214-702-2319
Mailing Address - Fax:
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:340
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:214-702-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional