Provider Demographics
NPI:1366983348
Name:MEAD, MALIA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:631 N WEBER ST STE 310
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1083
Mailing Address - Country:US
Mailing Address - Phone:719-749-8366
Mailing Address - Fax:719-634-5248
Practice Address - Street 1:631 N WEBER ST STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1083
Practice Address - Country:US
Practice Address - Phone:719-749-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist