Provider Demographics
NPI:1003395005
Name:KURNOCK, MALLORY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LYNN
Last Name:KURNOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15135-2203
Mailing Address - Country:US
Mailing Address - Phone:412-445-6162
Mailing Address - Fax:
Practice Address - Street 1:519 FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15135-2203
Practice Address - Country:US
Practice Address - Phone:412-445-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007743104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker