Provider Demographics
NPI:1851640718
Name:AUDRA MALCOMB CONSULTING INC
Entity Type:Organization
Organization Name:AUDRA MALCOMB CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/CSW-PIP
Authorized Official - Phone:605-381-0049
Mailing Address - Street 1:1929 RED DALE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3231
Mailing Address - Country:US
Mailing Address - Phone:605-381-0049
Mailing Address - Fax:
Practice Address - Street 1:1929 RED DALE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3231
Practice Address - Country:US
Practice Address - Phone:605-381-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health