Provider Demographics
NPI:1245805241
Name:MALLETT, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MALLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3005 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2143
Mailing Address - Country:US
Mailing Address - Phone:773-905-9024
Mailing Address - Fax:
Practice Address - Street 1:4440 LEXINGTON BLVD BLDG SUITE343
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2821
Practice Address - Country:US
Practice Address - Phone:281-846-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty