Provider Demographics
NPI:1114722113
Name:CEYROLLES, MALLORY MAE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:MAE
Last Name:CEYROLLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 DUNSDIN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7546
Mailing Address - Country:US
Mailing Address - Phone:317-938-4274
Mailing Address - Fax:
Practice Address - Street 1:8150 OAKLANDON RD STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9554
Practice Address - Country:US
Practice Address - Phone:463-290-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician