Individual
JUSTIN MALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LSW
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
LSW.0009924579
CO
Other
Enumeration date
05/08/2020
Last updated
01/21/2025
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