Provider Demographics
NPI:1346238607
Name:MALM, SHERRY KAYE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:KAYE
Last Name:MALM
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 HAGEN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7537
Mailing Address - Country:US
Mailing Address - Phone:928-855-4445
Mailing Address - Fax:
Practice Address - Street 1:474 HAGEN WAY
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7537
Practice Address - Country:US
Practice Address - Phone:928-855-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10672101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor