MEDICARE: MR. BOBBY LEE MALONE MS MSW AAMFT LBSW

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	106H00000X	Marriage & Family Therapist	21	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51095649MAL	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1518060185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOBBY LEE MALONE MS MSW AAMFT LBSW

Provider Business Mailing Address
First Line	:	PO BOX 1016
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36202-1016
Country	:	US
Telephone Number	:	256-770-7339
Fax Number	:	256-770-7338

Provider Business Practice Location Address
First Line	:	114 W 10TH ST
Second Line	:	SUITE D
City	:	ANNISTON
State	:	AL
Zip	:	36201-5614
Country	:	US
Telephone Number	:	256-770-7339
Fax Number	:	256-770-7338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/29/2013

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