Provider Demographics
NPI:1154573301
Name:MALONE, TIMOTHY T (BS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:MALONE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 WESLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4179
Mailing Address - Country:US
Mailing Address - Phone:903-455-9090
Mailing Address - Fax:
Practice Address - Street 1:2718 WESLEY ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4179
Practice Address - Country:US
Practice Address - Phone:903-455-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health