Mallory Hartman
Individual provider Active NPI Mental Health Counselor · Vienna, IL
NPI 1124404124 · NPPES record last updated Aug 3, 2015
Key facts
- NPI
- 1124404124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 408 E Vine St
Vienna, IL 62995-1612 - Phone
- (618) 658-2611
- NPI assigned
- Aug 3, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
408 E Vine St
Vienna, IL 62995-1612
Mailing address
4301 Boskydell Rd
Carbondale, IL 62903-7610
Other providers in Vienna, IL
- Lily Irene Greer
- Brittney Hale
- Chelsea Hall
- Pamela Hall
- Alexandra Hamilton
- Robin Hawk
- Amber Hayden
- Debra Hayes
- Marsha Hayes
- Coartney L Hedger
All providers in Vienna, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.