Provider Demographics
NPI:1780322255
Name:MALONE, JULIA YATES (MA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:YATES
Last Name:MALONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:HAMLIN
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1437 STANISLAUS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1479
Mailing Address - Country:US
Mailing Address - Phone:760-855-7653
Mailing Address - Fax:
Practice Address - Street 1:1437 STANISLAUS DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1479
Practice Address - Country:US
Practice Address - Phone:760-855-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist