Provider Demographics
NPI:1538831888
Name:RYALLS, MALLORY ROCHELLE
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ROCHELLE
Last Name:RYALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:281-660-1428
Mailing Address - Fax:
Practice Address - Street 1:4541 N BENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8828
Practice Address - Country:US
Practice Address - Phone:325-939-2650
Practice Address - Fax:432-426-6066
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician