Mallory Haglund
Individual provider Active NPI Addiction (Substance Use Disorder) Psychologist · Boulder, NV
NPI 1679949358 · NPPES record last updated Jul 18, 2018
Key facts
- NPI
- 1679949358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Psychologist 103TA0400X
- Practice address
- 284 West Rocky Lane
Boulder, NV 55114 - Phone
- (681) 664-5541
- NPI assigned
- Aug 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1125 | NV | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1125 | NV | |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | Yes |
Addresses
Primary practice location
284 West Rocky Lane
Boulder, NV 55114
Mailing address
3850 Las Vegas Blvd S
Las Vegas, NV 89109-4324
Other practice location 1
3850 Las Vegas Blvd S
Las Vegas, NV 89109-4324
Phone (651) 681-4567
Other providers in Boulder, NV
All providers in Boulder, NV · Addiction (Substance Use Disorder) Psychologist in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.