Provider Demographics
NPI:1760653695
Name:MALM, DOUGLAS ANDREW (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:MALM
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E MISSOURI AVE
Mailing Address - Street 2:SUITE 780
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2718
Mailing Address - Country:US
Mailing Address - Phone:602-326-7438
Mailing Address - Fax:602-513-7303
Practice Address - Street 1:1130 E MISSOURI AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2718
Practice Address - Country:US
Practice Address - Phone:602-326-7438
Practice Address - Fax:602-513-7303
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health