Active NPI
Laurel Meredith Malloy, MED, LPC
- Professional Counselor
- San Antonio, TX
National Provider Identifier
1013795871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 16255
- Practice address
- 5503 Grissom Rd Ste 110
San Antonio, TX 78238-3036 - Phone
- (210) 418-2546
- Fax
- (210) 429-7242
- NPI assigned
- Sep 21, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 16255 | TX | Primary |
Addresses
Primary practice location
5503 Grissom Rd Ste 110
San Antonio, TX 78238-3036
Mailing address
9451 Kirk Pond
San Antonio, TX 78240-2713
Phone (210) 682-4963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16255 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1013795871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9451 KIRK POND",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782402713",
"telephone_number": "210-682-4963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5503 GRISSOM RD STE 110",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782383036",
"telephone_number": "210-418-2546",
"fax_number": "210-429-7242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOY",
"first_name": "LAUREL",
"middle_name": "MEREDITH",
"name_prefix": "Ms.",
"credential": "MED, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-21",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "16255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.