Provider Demographics
NPI:1568900082
Name:MALANEY, JESSICA SUE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUE
Last Name:MALANEY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1370 N OAKLAND BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4525
Mailing Address - Country:US
Mailing Address - Phone:248-666-8870
Mailing Address - Fax:248-666-5023
Practice Address - Street 1:1370 N OAKLAND BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4525
Practice Address - Country:US
Practice Address - Phone:248-666-8870
Practice Address - Fax:248-666-5023
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional