Provider Demographics
NPI:1689065344
Name:MALLON, JAMES JOSEPH (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:MALLON
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 10TH AVE S
Mailing Address - Street 2:SUITE 210/212
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9402
Mailing Address - Country:US
Mailing Address - Phone:612-296-0152
Mailing Address - Fax:612-216-5479
Practice Address - Street 1:32 10TH AVE S
Practice Address - Street 2:SUITE 210/212
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-9402
Practice Address - Country:US
Practice Address - Phone:612-296-0152
Practice Address - Fax:612-216-5479
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health