Provider Demographics
NPI:1659825941
Name:MARGO MALONE
Entity type:Organization
Organization Name:MARGO MALONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-272-8177
Mailing Address - Street 1:3134 PETITE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7817
Mailing Address - Country:US
Mailing Address - Phone:318-272-8177
Mailing Address - Fax:
Practice Address - Street 1:3134 PETITE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7817
Practice Address - Country:US
Practice Address - Phone:318-272-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health