Provider Demographics
NPI:1871763573
Name:MALLON, TIMOTHY D (LMHC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:MALLON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 48TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443
Mailing Address - Country:US
Mailing Address - Phone:253-566-9700
Mailing Address - Fax:
Practice Address - Street 1:2601 70TH AVE W
Practice Address - Street 2:SUITE N
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-566-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010926101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor