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General NPI Number Information
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NPI Number | 1043850118
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Entity Type | Individual
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Provider Name | KIMBERLY A MALLETT PHD
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 807 ARAPAHOE ST
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City | GOLDEN
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State | CO
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Zip | 80401-1032
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Country | US
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Telephone | 720-815-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 958 8TH ST
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City | GOLDEN
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State | CO
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Zip | 80401-1005
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Country | US
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Telephone | 814-441-6398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY0005196
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License Number State | CO
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