Provider Demographics
NPI:1265240543
Name:MALLORY PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:MALLORY PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:615-412-8909
Mailing Address - Street 1:11205 LEBANON RD
Mailing Address - Street 2:PMB 1008
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5545
Mailing Address - Country:US
Mailing Address - Phone:615-412-8909
Mailing Address - Fax:615-358-9186
Practice Address - Street 1:40 BURTON HILLS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-5902
Practice Address - Country:US
Practice Address - Phone:615-412-8909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty