MEDICARE: STUART MALKIN COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	R4845	OR
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1609391309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART MALKIN COUNSELING

Provider Business Mailing Address
First Line	:	1625 MEADOWS DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-6123
Country	:	US
Telephone Number	:	971-266-1693
Fax Number	:	503-387-3757

Provider Business Practice Location Address
First Line	:	1625 MEADOWS DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-6123
Country	:	US
Telephone Number	:	971-266-1693
Fax Number	:	503-387-3757

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	STUART MALKIN
Credential	:	MS, LPC
Telephone Number	:	971-266-1693

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	10/27/2023

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