Basic Information
| Provider Information | |||||||||
| NPI: | 1568900082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALANEY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 N OAKLAND BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486668870 | ||||||||
| FaxNumber: | 2486665023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 N OAKLAND BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486668870 | ||||||||
| FaxNumber: | 2486665023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2017 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401015913 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.