Provider Demographics
NPI:1194238089
Name:MALLOY, WILLIAM PAUL
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:MALLOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 HWY J NORTH
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0441
Mailing Address - Country:US
Mailing Address - Phone:573-359-2600
Mailing Address - Fax:
Practice Address - Street 1:925 STATE HWY VV
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:36857
Practice Address - Country:US
Practice Address - Phone:573-359-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)