Provider Demographics
NPI:1245805241
Name:MALLETT, EBONY
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MALLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7235 TOLUCA DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4461
Mailing Address - Country:US
Mailing Address - Phone:773-905-9024
Mailing Address - Fax:
Practice Address - Street 1:3737 DACOMA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8905
Practice Address - Country:US
Practice Address - Phone:346-455-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty