Provider Demographics
NPI:1013795871
Name:MALLOY, LAUREL MEREDITH (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:MEREDITH
Last Name:MALLOY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9451 KIRK POND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2713
Mailing Address - Country:US
Mailing Address - Phone:210-682-4963
Mailing Address - Fax:
Practice Address - Street 1:5503 GRISSOM RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3036
Practice Address - Country:US
Practice Address - Phone:210-418-2546
Practice Address - Fax:210-429-7242
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional