Provider Demographics
NPI:1730502188
Name:BROWN, MALLORY (MS, PLMHP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6408
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-6408
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist