Provider Demographics
NPI:1417673773
Name:MALONEY, KELSEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:AUTUMN
Other - Last Name:LODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3438
Mailing Address - Country:US
Mailing Address - Phone:901-448-3420
Mailing Address - Fax:901-448-3740
Practice Address - Street 1:920 MADISON AVE FL 9
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3438
Practice Address - Country:US
Practice Address - Phone:901-448-3420
Practice Address - Fax:901-448-3740
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical