Provider Demographics
NPI:1992399737
Name:MALONE, KATELYN ROSE (LPC-A)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 NE ZAC LENTZ PKWY APT 126
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3153
Mailing Address - Country:US
Mailing Address - Phone:281-728-9244
Mailing Address - Fax:
Practice Address - Street 1:4702 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2147
Practice Address - Country:US
Practice Address - Phone:361-572-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional