KATRINA MALLORY (NPI# 1750718920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750718920 |
| Entity Type | Individual |
| Full Name | KATRINA MALLORY |
| Practice Address |
3700 W Kilgore Ave Muncie IN 47304-4810 |
| Practice Telephone | 7652895437 |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2019-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TH0100X |
Psychologist Specialization: Health Service |
Behavioral Health & Social Service Providers |
| Street Address |
3700 W KILGORE AVE |
| City | MUNCIE |
| State | IN |
| Zip Code | 47304-4810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134276884 | Youth Opportunity Center, Inc | Psychiatric Residential Treatment Facility | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2007-01-04 |
| 1992302368 | Mckenzie Slagle | Counselor | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-10-07 |
| 1841807294 | Courtney Alane Eaddy-richardson | Student in an Organized Health Care Education/Training Program | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-09-29 |
| 1386250462 | Kalyn M Gebhardt | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-09-23 |
| 1063036903 | Margaret Ann Dorfner | Counselor | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-06-06 |
| 1710500574 | Brandy Latrice Pugh | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-05-27 |
| 1396368403 | Ebony Logan | Student in an Organized Health Care Education/Training Program | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-05-22 |
| 1255964367 | Andrea Grace Trinidad | Counselor | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2020-02-17 |
| 1790326312 | Cass G Winters | Counselor | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2019-10-04 |
| 1053960021 | Jessica Simpson | Counselor | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2019-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821627191 | Free To Flourish Counseling and Consulting | Marriage & Family Therapist | 4304 W Coyote Run Court, Muncie, IN 47304 | 2020-04-07 |
| 1205477957 | Muncie Treatment Center, LLC | Clinic/Center | 3640 Briarwood Lane, Muncie, IN 47304 | 2019-10-03 |
| 1508415225 | Susanna Florence Nalliah I | Pharmacist | Iu Health Ball Memorial Hospital Inpatient Pharmacy, 2401 W. University Ave, Muncie, IN 47304 | 2019-09-05 |
| 1235624289 | Kregg Koons O.d., Inc. | Optometrist | 3300 Purdue Ave., Muncie, IN 47304 | 2018-06-22 |
| 1013409242 | Julia Powers | Social Worker | 8425 W Ashford Ln, Muncie, IN 47304 | 2018-06-04 |
| 1851803456 | Dianna Marie Johnson | Nurse Practitioner | 3411 N Briarwood Ln, Muncie, IN 47304 | 2017-11-04 |
| 1780082917 | Quad Med LLC | Clinic/Center | 3800 West Kilgore Ave, Muncie, IN 47304 | 2014-12-22 |
| 1629418173 | Mark Allen Wise | Physical Therapist | 3607 N Everbrook Lane, Muncie, IN 47304 | 2013-06-28 |
| 1396094280 | Planned Parenthood of Indiana Muncie | Clinic/Center | 3550 W. Fox Ridge Lane, Muncie, IN 47304 | 2012-09-06 |
| 1043595655 | Olukayode Bamidele | Physical Therapist | 3601 W. Moore Road, Muncie, IN 47304 | 2011-10-14 |
| Find all providers in zip 47304 | ||||
| Taxonomy Code | 103TH0100X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health Service |
| A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |
| Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265733026 | Robyn N. Eubank | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2010-11-10 |
| 1437395910 | Robin D Kohli | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2009-01-05 |
| 1942451224 | Youth Opportunity Center, Inc. | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2008-10-06 |
| 1538319421 | Youth Opportunity Center | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2008-09-26 |
| 1811163512 | Youth Opportunity Center Inc | Psychologist | 3700 W Kilgore Ave, Muncie, IN 47304-4810 | 2008-05-02 |
| 1912054008 | Linda Lea Daniel | Psychologist | 221 N Celia Ave, Muncie, IN 47303-4609 | 2007-01-04 |
| 1225081599 | Mary Jo Roseberry | Psychologist | 240 N Tillotson Ave, Muncie, IN 47304-3988 | 2006-05-18 |
| 1164474961 | Ross G Lane | Psychologist | 240 N Tillotson Ave, Muncie, IN 47304-3988 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962993063 | Nicole C Allen | Psychologist | 595 W Edge Trl Apt O, Avon, IN 46123-6841 | 2018-05-24 |
| 1720436488 | Youth Opportunity Center | Psychologist | 103 W County Road 100 N, New Castle, IN 47362-8965 | 2016-06-02 |
| 1528449964 | Leroy Burgess | Psychologist | 300 S Saint Louis Blvd Ste 202, South Bend, IN 46617-3044 | 2015-06-11 |
| 1144555855 | Paula A. Neuman | Psychologist | 750 Broadway Ste 350, Fort Wayne, IN 46802-1412 | 2009-10-14 |
| 1942491600 | Dixie J Pederson | Psychologist | 2 N 19th St, Lafayette, IN 47904-2950 | 2007-08-07 |
| 1285839480 | Center for Brief Therapy PC | Psychologist | 423 Airport N. Office Park, Ft. Wayne, IN 46825-6704 | 2007-06-18 |
| 1376600767 | Bart Ferraro | Psychologist | 2011 N Meridian St, Indianapolis, IN 46202-1305 | 2007-01-03 |
| 1326125998 | Mary Wollitz Dooley | Psychologist | 7125 E Us Hwy 36, Avon, IN 46123 | 2006-11-01 |
| 1235247396 | Linda Ohlsen Ferreira | Psychologist | 23 East 39th Street, Indianapolis, IN 46205-2645 | 2006-08-29 |
| 1497798284 | Victory Clinical Services II LLC | Psychologist | 4218 W Western Ave, South Bend, IN 46619-2622 | 2006-06-13 |
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| 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.