Healthcare Provider Details

I. General information

NPI: 1265697759
Provider Name (Legal Business Name): SCOTT VERNON MALON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES VERNON MALON PH.D.

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RIVERSIDE AVE APT 2
SANTA CRUZ CA
95060-4534
US

IV. Provider business mailing address

815 RIVERSIDE AVE APT 2
SANTA CRUZ CA
95060-4534
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-3361
  • Fax:
Mailing address:
  • Phone: 831-426-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY5560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: