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NPI Code Detail

MEDICARE: MS. RUTH E. ZUM MALLEN M.A. LPC NCC

MEDICARE: MS. RUTH E. ZUM MALLEN M.A. LPC NCC
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
1101YM0800XMental Health CounselorLPC-10819AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1809907OTHERAZAHCCCS PROVIDER ID
266218OTHERNBCC
3LPC-10819OTHERAZSTATE LICENSE

General Provider Information

NPI Number : 1356309488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUTH E. ZUM MALLEN M.A. LPC NCC
Provider Business Mailing Address
First Line : 1588 CARPENTER LN
Second Line :
City : COTTONWOOD
State : AZ
Zip : 86326-5061
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8 E COTTONWOOD ST
Second Line :
City : COTTONWOOD
State : AZ
Zip : 86326-4382
Country : US
Telephone Number : 928-634-2236
Fax Number : 928-634-8960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 07/08/2007

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