MEDICARE: MS. SHERRY KAYE MALM MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC10672	AZ

General Provider Information

NPI Number	:	1346238607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRY KAYE MALM MA LPC

Provider Business Mailing Address
First Line	:	474 HAGEN WAY
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-7537
Country	:	US
Telephone Number	:	928-855-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 HAGEN WAY
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-7537
Country	:	US
Telephone Number	:	928-855-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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