Provider Demographics
NPI:1417237652
Name:MALLOY, NATALIE N (LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:N
Last Name:MALLOY
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:N
Other - Last Name:BEHIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4243 MIDDLEBRANCH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2737
Mailing Address - Country:US
Mailing Address - Phone:513-260-2251
Mailing Address - Fax:
Practice Address - Street 1:4450 BELDEN VILLAGE ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2552
Practice Address - Country:US
Practice Address - Phone:513-260-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000130101YM0800X
OHICDC.131248101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)