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General NPI Number Information
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NPI Number | 1871701656
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Entity Type | Organization
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Legal Business Name | KAREN W. MALM, PH.D., P.C.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4018 RASMUSSEN RD
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City | PARK CITY
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State | UT
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Zip | 84098-4705
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Country | US
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Telephone | 801-599-0924
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Fax | 435-649-7266
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Provider Business Mailing Address
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Address Line | PO BOX 982678
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City | PARK CITY
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State | UT
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Zip | 84098-2678
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Country | US
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Telephone | 801-599-0924
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Fax | 435-649-7266
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Authorized Official
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Title or Position | OWNER
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Name | KAREN WHEELOCK MALM
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Credential | PH.D.
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Telephone | 801-599-0924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 116826-2501
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License Number State | UT
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