Provider Demographics
NPI:1750074464
Name:ABY MALLEY PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:ABY MALLEY PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-988-3576
Mailing Address - Street 1:300 HUNTER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2081
Mailing Address - Country:US
Mailing Address - Phone:970-988-3576
Mailing Address - Fax:
Practice Address - Street 1:300 HUNTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63124-2081
Practice Address - Country:US
Practice Address - Phone:970-988-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health