Provider Demographics
NPI:1649959040
Name:MALLORY ADAMS COUNSELING, LLC
Entity type:Organization
Organization Name:MALLORY ADAMS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-503-9990
Mailing Address - Street 1:104 ABERCROMBIE WAY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6895
Mailing Address - Country:US
Mailing Address - Phone:318-547-1402
Mailing Address - Fax:
Practice Address - Street 1:221 RUE DE JEAN STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8501
Practice Address - Country:US
Practice Address - Phone:337-484-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty