Provider Demographics
NPI:1053111658
Name:MUSE, MALLORY LEANNE (LMHP-R)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LEANNE
Last Name:MUSE
Suffix:
Gender:
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2126
Mailing Address - Country:US
Mailing Address - Phone:757-529-8844
Mailing Address - Fax:757-525-4927
Practice Address - Street 1:4020 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2126
Practice Address - Country:US
Practice Address - Phone:757-529-8844
Practice Address - Fax:757-525-4927
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional