Provider Demographics
NPI:1982980272
Name:MALLORY, DANNY LEON JR (LMFT 132578)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LEON
Last Name:MALLORY
Suffix:JR
Gender:M
Credentials:LMFT 132578
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N BROOKHURST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5229
Mailing Address - Country:US
Mailing Address - Phone:657-276-4309
Mailing Address - Fax:
Practice Address - Street 1:511 N BROOKHURST ST STE 200
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5229
Practice Address - Country:US
Practice Address - Phone:657-276-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132578106H00000X, 106H00000X
225400000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program