Provider Demographics
NPI:1720300916
Name:MALONE, CHASTIDY SHAUNE (MA)
Entity Type:Individual
Prefix:
First Name:CHASTIDY
Middle Name:SHAUNE
Last Name:MALONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 KATY FWY STE 490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1608
Mailing Address - Country:US
Mailing Address - Phone:281-597-9291
Mailing Address - Fax:281-597-9761
Practice Address - Street 1:11999 KATY FWY STE 490
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1608
Practice Address - Country:US
Practice Address - Phone:281-597-9291
Practice Address - Fax:281-597-9761
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional