Organization
TALITHA KOUM PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNTELLE MALCOLM PMHNP (OWNER)
(617) 615-1772
Entity
Organization
Contact information
Practice address
500 GRANITE AVE, MILTON, MA 02186-5626
(617) 858-4024
Mailing address
52 HOLLINGSWORTH RD, MILTON, MA 02186-1019
(617) 615-1772
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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