Individual
PAUL DOUGLAS MALLAMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1009 E OLD HIGHWAY 56, OLATHE, KS 66061-4969
(913) 764-7555
(913) 764-0739
Mailing address
1601 OLD SOUTH RIVER RD, SAINT CHARLES, MO 63303-4120
(636) 224-1210
(636) 246-1008
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1677
KS
Other
Enumeration date
02/11/2021
Last updated
02/11/2021
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