Provider Demographics
NPI:1659805570
Name:MALONE, LEE ANN (MA, LADC)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:LEE ANN
Other - Middle Name:
Other - Last Name:CHMELOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 KEELE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2337
Mailing Address - Country:US
Mailing Address - Phone:775-351-9863
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST, STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-322-8941
Practice Address - Fax:775-322-1544
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVL-1158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)