Mallory Fountain, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801105102 Issued in MI

Practice address

229 E Michigan Ave Ste 345
Kalamazoo, MI 49007-6403

Phone

(269) 254-6613

NPI assigned

Sep 19, 2019

Last updated

Apr 11, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2026 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mallory Fountain, PLLC

  • Clinical Social Worker
  • Scotts, MI
  • NPI 1275492191
  NPD Authorized official
• Kelsea a Howell PLLC

  dba Atlas Counseling & Psychotherapy Services

  • Counselor
  • Kalamazoo, MI
  • NPI 1649765298

  Social Worker

  NPD (past)

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1528618725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 E MICHIGAN AVE STE 345",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490076403",
            "telephone_number": "269-370-9074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 E MICHIGAN AVE STE 345",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490076403",
            "telephone_number": "269-254-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "MALLORY",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-19",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801105102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David J Foster, D.D.S.
• Glenn Andrew Foster, MA
• Foundations Christian Counseling
• Gabraelle Elizabeth Foune, FNP-C
• Kelsea Foune, DO
• Fountains Bronson Place SL, LLC (The Springs at the Fountains)
• Nannette Foust
• Christopher Fowler, LLMSW
• Psontia Fowler
• Matthew S Fox, LMSW

• Social Worker in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.