Provider Demographics
NPI:1881701423
Name:MALONE, SUSAN (LPCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 DON FRANCISCO PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2653
Mailing Address - Country:US
Mailing Address - Phone:505-263-7058
Mailing Address - Fax:505-341-9205
Practice Address - Street 1:1233 DON FRANCISCO PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2653
Practice Address - Country:US
Practice Address - Phone:505-263-7058
Practice Address - Fax:505-341-9205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD1621Medicaid