Provider Demographics
NPI:1588359970
Name:MALAVER PARADA, CARLOS (LAC, LCP)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:MALAVER PARADA
Suffix:
Gender:M
Credentials:LAC, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BEAR PAW PL
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6438
Mailing Address - Country:US
Mailing Address - Phone:406-468-8425
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-468-8425
Practice Address - Fax:406-453-1314
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-31276101YM0800X
MTBBH-LAC-LIC-62715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health