Provider Demographics
NPI:1841630530
Name:NJUGUNA, MALLORY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:NJUGUNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 COLLIN MCKINNEY PKWY APT 3037
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7825
Mailing Address - Country:US
Mailing Address - Phone:713-561-1343
Mailing Address - Fax:
Practice Address - Street 1:17440 DALLAS PKWY STE 218
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7308
Practice Address - Country:US
Practice Address - Phone:469-321-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57796104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker