Provider Demographics
NPI:1952627846
Name:MALONE, TAMELA S (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:S
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMELA
Other - Middle Name:SUZETTE
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:10816 CROWN COLONY DR STE 211
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1677
Mailing Address - Country:US
Mailing Address - Phone:512-588-3088
Mailing Address - Fax:
Practice Address - Street 1:10816 CROWN COLONY DR STE 211
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1677
Practice Address - Country:US
Practice Address - Phone:512-588-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53656104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker