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NPI Code Detail

MEDICARE: MS. TWYLA MALCOM LPC

MEDICARE:  MS. TWYLA  MALCOM  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
1101YP2500XProfessional Counselor10630-125WI
2101YP2500XProfessional Counselor6401017765MI

General Provider Information

NPI Number : 1942692926
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TWYLA MALCOM LPC
Provider Business Mailing Address
First Line : 7789 KENNETT SQ
Second Line :
City : WEST BLOOMFIELD
State : MI
Zip : 48322-5012
Country : US
Telephone Number : 248-949-0681
Fax Number :
Provider Business Practice Location Address
First Line : 43996 WOODWARD AVE STE 5
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-5049
Country : US
Telephone Number : 248-876-3893
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2015
Last Update Date : 09/10/2024

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Directions to “ MS. TWYLA MALCOM LPC” Practice Location

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