MEDICARE: ROBERT J. MALEY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1295910537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J. MALEY, PLLC

Provider Business Mailing Address
First Line	:	445 E CHEYENNE MOUNTAIN BLVD
Second Line	:	STE. C #132
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1528
Country	:	US
Telephone Number	:	719-930-9664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 N ACADEMY BLVD
Second Line	:	SUITE 107
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3317
Country	:	US
Telephone Number	:	719-930-9664
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. ROBERT J. MALEY
Credential	:	L.P.C.
Telephone Number	:	719-930-9664

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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