Provider Demographics
NPI:1831378074
Name:MALONE, MARJORIE (PHD, LPCC)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:209 LAS CRUCES LANE
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-2070
Mailing Address - Country:US
Mailing Address - Phone:505-758-1565
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ROAD
Practice Address - Street 2:6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACSAC II 169101YA0400X
NMLPCC 96621101YM0800X
NMLPCC 96621101YP2500X, 102L00000X
CALMFT 43969102L00000X, 106H00000X
NM0096621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist