Provider Demographics
NPI:1467865303
Name:MAO, MALLORY YOUNGHONG (EDD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:YOUNGHONG
Last Name:MAO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-9203
Mailing Address - Country:US
Mailing Address - Phone:502-744-7422
Mailing Address - Fax:
Practice Address - Street 1:3326 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-9203
Practice Address - Country:US
Practice Address - Phone:502-744-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1111103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling