Provider Demographics
NPI:1497865877
Name:MALONE, GARY A (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:MALONE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5023
Mailing Address - Country:US
Mailing Address - Phone:559-447-9468
Mailing Address - Fax:559-228-8329
Practice Address - Street 1:125 E BARSTOW AVE STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5023
Practice Address - Country:US
Practice Address - Phone:559-447-9468
Practice Address - Fax:559-228-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist