Connie Mallory, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

59983 Issued in TX

Practice address

5936 Mercedes Ave
Dallas, TX 75206-5910

Phone

(214) 288-6854

NPI assigned

Apr 30, 2022

Last updated

Apr 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651276800000",
    "number": "1316682768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5936 MERCEDES AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752065910",
            "telephone_number": "214-288-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5936 MERCEDES AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752065910",
            "telephone_number": "214-288-6854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5936 Mercedes Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752065910",
            "country_code": "US",
            "telephone_number": "214-288-6854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "CONNIE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-30",
        "last_updated": "2022-04-30",
        "certification_date": "2022-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": "59983",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "59983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Damien B Mallat, MD
• Sreenadh Mallavalli, PHARMD
• Denise Mallea
• Alka Mallik, M.D.
• Jessica Lynne Mallison, PA-C
• Dejanira Breona Mallory, OTR
• Mary Margaret Mallory, R.N., PNP
• Jenifer Ranft Mallow, DNP, FNP-BC
• Craig Riggs Malloy, M.D.
• Ellen Therese Malloy, RN,NP

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.