Individual provider · Type 1 NPI

Mallory Hartman

Mental Health Counselor · Vienna, IL

NPI number 1124404124 Active

Practice location

408 E Vine St
Vienna, IL 62995-1612

Mailing address

4301 Boskydell Rd
Carbondale, IL 62903-7610

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1124404124

Mallory Hartman's National Provider Identifier is 1124404124, issued on Aug 3, 2015. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Vienna, IL. The record was last updated on Aug 3, 2015.