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General NPI Number Information
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NPI Number | 1548520620
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Entity Type | Individual
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Provider Name | MICHAEL DAVID MALONE M.A.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 100 COURT ST
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City | TUPELO
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State | MS
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Zip | 38804-3900
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Country | US
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Telephone | 662-844-4254
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 BAKER RD
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City | LAKE CORMORANT
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State | MS
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Zip | 38641-9217
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Country | US
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Telephone | 662-386-7336
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0506
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License Number State | MS
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