MR. JACK EUGENE MALLERY LPC NPI 1700969383

NPI Information

NPI: 1700969383
Provider Name: MR. JACK EUGENE MALLERY, LPC
Classification: Marriage & Family Therapist - 106H00000X
Entity Type: Individual
Address:
7305 HAMPTON BLVD
NORFOLK, VA
ZIP 23505
Phone: (757) 623-2700
Get Directions

MR. Jack Eugene Mallery, LPC is a marriage family therapist in Norfolk, VA. The provider is a marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. MR. Jack Eugene Mallery, LPC NPI is 1700969383. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

7305 HAMPTON BLVD
NORFOLK, VA
ZIP 23505-908
Phone: (757) 623-2700
Fax: (757) 640-1058

The enumeration date for this NPI number is 10/24/2006 and was last updated on 12/12/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	0718000021	VIRGINIA	No
2	101YM0800X	Counselor	Mental Health	0701002423	VIRGINIA	No
3	175T00000X	Peer Specialist				No
4	106H00000X	Marriage & Family Therapist		0717000586	VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004945395	OTHER	VIRGINIA	PROVIDER NUMBER
2	175080	OTHER	VIRGINIA	PROVIDER NUMBER
3	004945395	MEDICAID	VIRGINIA
4	083239M	OTHER	VIRGINIA	PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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