GWENDOLYN MALLORY


Address: 4550 W Sahara Ave Apt 1241, Las Vegas, NV 89102-3648
Phone: 9096008373

GWENDOLYN MALLORY (NPI# 1225666597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1225666597
Entity Type Individual
Full Name GWENDOLYN MALLORY
Credential QMHA
Practice Address 4550 W Sahara Ave Apt 1241
Las Vegas
NV 89102-3648
Practice Telephone 9096008373
Mailing Telephone 9096008373
Enumeration Date 2020-03-31
Last Update Date 2020-06-17
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
02632-I NV Behavioral Health & Social Service Providers

Office Location

Street Address 4550 W SAHARA AVE APT 1241
City LAS VEGAS
State NV
Zip Code 89102-3648

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NPI Name Taxonomy Address Enumeration
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1922629765 Bianca Vaudreuil Religious Nonmedical Practitioner 3210 W Charleston Ste 2, Las Vegas, NV 89102 2020-05-04
1720608052 Angelica Gutierrez Technician Vegas Compassionate Care ; 2820 W. Charleston Blvd B-21, Las Vegas, NV 89102 2020-04-16
1396370680 Juana Maria Hernandez Technician 2881 S. Valley View Blvd, Suite #6, Las Vegas, NV 89102 2020-03-06
1609409648 Janie Washington Technician 3210 W Charleston Blvd. Suite 2, Las Vegas, NV 89102 2020-02-18
1447893185 Maria Josefina Castaneda Technician 2881 S. Valley View Blvd Suite #6, Los Vegas, NV 89102 2019-10-25
1427608777 Virginia Hernandez Tolentino Technician 4550 W Oakley Blvd, Suite 101 A, Las Vegas, NV 89102 2019-09-18
1972153872 Gladiola Cardoza Quinones Technician 2881 S. Valley View Blvd #6, Las Vegas, NV 89102 2019-09-13
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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

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1811532781 Melanie Fedraw Counselor 3661 S Maryland Pkwy Ste 64, Las Vegas, NV 89169-3005 2019-11-14
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1902450455 Tracey Anora Henry Counselor 3675 Pecos Mecleod Ste 900, Las Vegas, NV 89121 2019-08-01
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Competitor

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City LAS VEGAS
Zip Code 89102

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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