Provider Demographics
NPI:1194157966
Name:MALCOLM COUNSELING AND DUI SERVICES, LLC.
Entity type:Organization
Organization Name:MALCOLM COUNSELING AND DUI SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR, DUI ASSESSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, CM-III
Authorized Official - Phone:405-637-5935
Mailing Address - Street 1:4500 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-3406
Mailing Address - Country:US
Mailing Address - Phone:405-601-5553
Mailing Address - Fax:
Practice Address - Street 1:4500 N LINCOLN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-3406
Practice Address - Country:US
Practice Address - Phone:405-601-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK698101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty