Active NPI
Anthony Mallace, MS
- Counselor
- Fort Lauderdale, FL
National Provider Identifier
1649402835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- MH1149
- Practice address
- 2699 Stirling Road
Suite B304
Ft. Lauderdale, FL 33312 - Phone
- (954) 432-8757
- NPI assigned
- Aug 20, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | MH1149 | FL | Primary |
Addresses
Primary practice location
2699 Stirling Road
Suite B304
Ft. Lauderdale, FL 33312
Mailing address
8320 NW 11TH Court
Pembroke Pines, FL 33024
Phone (954) 432-8757
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH1149 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250726400000",
"number": "1649402835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8320 NW 11TH COURT",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "33024",
"telephone_number": "954-432-8757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2699 STIRLING ROAD",
"address_2": "SUITE B304",
"city": "FT. LAUDERDALE",
"state": "FL",
"postal_code": "33312",
"telephone_number": "954-432-8757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLACE",
"first_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-20",
"last_updated": "2009-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "MH1149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.