Provider Demographics
NPI:1841348968
Name:MALEY, MICHAEL JOHN (MICHAEL MALEY, PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MALEY
Suffix:
Gender:M
Credentials:MICHAEL MALEY, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 HIDDEN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2559
Mailing Address - Country:US
Mailing Address - Phone:952-542-9480
Mailing Address - Fax:952-938-0158
Practice Address - Street 1:2717 HIDDEN CREEK LN
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2559
Practice Address - Country:US
Practice Address - Phone:952-542-9480
Practice Address - Fax:952-938-0158
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-94139OtherMEDICA
MN84761OtherHEALTH PARTNERS
MN10673 MAOtherBCBS