Active NPI
Gwendolyn Mallory, QMHA
- Addiction (Substance Use Disorder) Counselor
- Las Vegas, NV
National Provider Identifier
1225666597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 02632-I
- Practice address
- 4550 W Sahara Ave Apt 1241
Las Vegas, NV 89102-3648 - Phone
- (909) 600-8373
- NPI assigned
- Mar 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 02632-I | NV | Primary |
Addresses
Primary practice location
4550 W Sahara Ave Apt 1241
Las Vegas, NV 89102-3648
Mailing address
4550 W Sahara Ave Apt 1241
Las Vegas, NV 89102-3648
Phone (909) 600-8373
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02632-I | NV | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1225666597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4550 W SAHARA AVE APT 1241",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891023648",
"telephone_number": "909-600-8373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4550 W SAHARA AVE APT 1241",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891023648",
"telephone_number": "909-600-8373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "GWENDOLYN",
"credential": "QMHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-31",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NV",
"license": "02632-I",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.