Healthcare Provider Details

I. General information

NPI: 1710950902
Provider Name (Legal Business Name): ROYCE VERNON MALPHRUS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41B MARSHELLEN DR
BEAUFORT SC
29902-6901
US

IV. Provider business mailing address

41B MARSHELLEN DR
BEAUFORT SC
29902-6901
US

V. Phone/Fax

Practice location:
  • Phone: 843-812-5682
  • Fax: 843-522-8569
Mailing address:
  • Phone: 843-812-5682
  • Fax: 843-522-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number327, 1010
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: