Healthcare Provider Details

I. General information

NPI: 1356309488
Provider Name (Legal Business Name): RUTH E. ZUM MALLEN M.A. LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E COTTONWOOD ST
COTTONWOOD AZ
86326-4382
US

IV. Provider business mailing address

1588 CARPENTER LN
COTTONWOOD AZ
86326-5061
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-2236
  • Fax: 928-634-8960
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-10819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: