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General NPI Number Information
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NPI Number | 1417380874
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY INNOVATIONS, PLC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 1130 E MISSOURI AVE SUITE 780
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City | PHOENIX
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State | AZ
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Zip | 85014-2718
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Country | US
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Telephone | 602-326-7438
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Fax | 602-513-7303
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Provider Business Mailing Address
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Address Line | 1130 E MISSOURI AVE SUITE 780
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City | PHOENIX
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State | AZ
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Zip | 85014-2718
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Country | US
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Telephone | 602-326-7438
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Fax | 602-513-7303
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS ANDREW MALM
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Credential | PSY. D.
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Telephone | 602-326-7438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-12213
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License Number State | AZ
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