Provider Demographics
NPI:1467598227
Name:MALONE, KEVYLON DELEASE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KEVYLON
Middle Name:DELEASE
Last Name:MALONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8126 VILLA DEL VIENTO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1664
Mailing Address - Country:US
Mailing Address - Phone:702-228-8707
Mailing Address - Fax:702-228-8707
Practice Address - Street 1:4660 S EASTERN AVE STE 201A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6139
Practice Address - Country:US
Practice Address - Phone:702-283-5387
Practice Address - Fax:702-228-8707
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3045-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health