Provider Demographics
NPI:1548781925
Name:MALICH, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MALICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1140
Mailing Address - Country:US
Mailing Address - Phone:414-335-9512
Mailing Address - Fax:406-215-4597
Practice Address - Street 1:520 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2518
Practice Address - Country:US
Practice Address - Phone:406-200-9421
Practice Address - Fax:406-215-4597
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-247971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical