Individual provider Active NPI

Loren A Malkasian, M.A.; LMHC

  • Marriage & Family Therapist
  • Surfside Beach, SC
National Provider Identifier
1649277740
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
4711 Issued in SC
Practice address
1500 Highway 17 N Ste 201
Surfside Beach, SC 29575-6078
Phone
(508) 254-0066
NPI assigned
Jul 5, 2005
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LMHC 4564 MA
Marriage & Family Therapist 106H00000X 4711 SC Primary

Addresses

Primary practice location

1500 Highway 17 N Ste 201
Surfside Beach, SC 29575-6078

Mailing address

502 Lumber St
Nichols, SC 29581-5074
Phone (508) 254-0066

Other identifiers 1

IdentifierTypeStateIssuer
1890727MedicaidMA

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

LicenseStateTypeSpecialty
LMHC 4564MAMDMental Health Counselor
4711SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Clear Counseling Mental Health CurrentSince Apr 14, 2024 Accepting new patients

Locations

1500 Highway 17 N
Ste 201
Surfside Beach, SC 29575
Phone (508) 254-0066

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1649277740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 LUMBER ST",
            "city": "NICHOLS",
            "state": "SC",
            "postal_code": "295815074",
            "telephone_number": "508-254-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 HIGHWAY 17 N STE 201",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295756078",
            "telephone_number": "508-254-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALKASIAN",
        "first_name": "LOREN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "M.A.; LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC 4564",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "SC",
            "license": "4711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1890727",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surfside Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.