Provider Demographics
NPI:1710672761
Name:MALACARA, AUDREY BETH
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:BETH
Last Name:MALACARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 DALLAS PARKWAY
Mailing Address - Street 2:106
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:469-458-2031
Mailing Address - Fax:
Practice Address - Street 1:14651 DALLAS PARKWAY
Practice Address - Street 2:106
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:469-458-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty