Provider Demographics
NPI:1740258524
Name:MALONEY, JOHN J (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MALONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 E KINGSLEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7222
Mailing Address - Country:US
Mailing Address - Phone:417-887-4245
Mailing Address - Fax:417-881-7004
Practice Address - Street 1:1358 E KINGSLEY ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7222
Practice Address - Country:US
Practice Address - Phone:417-881-1580
Practice Address - Fax:417-881-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01215103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499454205Medicaid
MO000071286Medicare ID - Type Unspecified