Provider Demographics
NPI:1891486825
Name:HUGHES, MALACHI AXAVIER I
Entity Type:Individual
Prefix:
First Name:MALACHI
Middle Name:AXAVIER
Last Name:HUGHES
Suffix:I
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 1:1477 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1029
Mailing Address - Country:US
Mailing Address - Phone:816-337-8705
Mailing Address - Fax:
Practice Address - Street 1:1477 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1029
Practice Address - Country:US
Practice Address - Phone:816-337-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician