Provider Demographics
NPI:1053740464
Name:CANDELL, MALLORY (LMFT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:CANDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2091
Mailing Address - Country:US
Mailing Address - Phone:651-207-3796
Mailing Address - Fax:
Practice Address - Street 1:345 UNIVERSITY AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2091
Practice Address - Country:US
Practice Address - Phone:651-207-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist