Provider Demographics
NPI:1174359996
Name:DETRANALTES, MALLORY M (LPC-A)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:M
Last Name:DETRANALTES
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4798 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3100
Mailing Address - Country:US
Mailing Address - Phone:281-750-5453
Mailing Address - Fax:
Practice Address - Street 1:7002 RIVERBROOK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6530
Practice Address - Country:US
Practice Address - Phone:281-516-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health