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General NPI Number Information
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NPI Number | 1194157966
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Entity Type | Organization
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Legal Business Name | MALCOLM COUNSELING AND DUI SERVICES, LLC.
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 4500 N LINCOLN BLVD SUITE 105
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-3406
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Country | US
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Telephone | 405-601-5553
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 N LINCOLN BLVD SUITE 105
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-3406
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Country | US
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Telephone | 405-601-5553
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Fax |
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Authorized Official
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Title or Position | OWNER, COUNSELOR, DUI ASSESSOR
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Name | MR. LAMONT RUDOLPH MALCOLM
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Credential | LADC, CM-III
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Telephone | 405-637-5935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 698
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License Number State | OK
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