Healthcare Provider Details

I. General information

NPI: 1831472471
Provider Name (Legal Business Name): CHARLOTTE MALKMUS MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 16TH AVE
SEATTLE WA
98122-4011
US

IV. Provider business mailing address

1601 16TH AVE
SEATTLE WA
98122-4011
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-3240
  • Fax: 206-461-3696
Mailing address:
  • Phone: 206-461-3240
  • Fax: 206-461-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60225428
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004229-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: