Provider Demographics
NPI:1194143404
Name:MALOY, KEVIN PATRICK (MA,MHP,LMHC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PATRICK
Last Name:MALOY
Suffix:
Gender:M
Credentials:MA,MHP,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 105TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8701
Mailing Address - Country:US
Mailing Address - Phone:206-369-1211
Mailing Address - Fax:
Practice Address - Street 1:727 N 182ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-369-1211
Practice Address - Fax:206-542-5235
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60618188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health