Individual
MR. LAMONT RUDOLPH MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, CBHCM
Contact information
Practice address
2701 N OKLAHOMA AVE, OKLAHOMA CITY, OK 73105-2724
(405) 528-8686
(405) 528-8692
Mailing address
2701 N OKLAHOMA AVE, OKLAHOMA CITY, OK 73105-2724
(405) 528-8686
(405) 528-8692
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
698
OK
101YM0800X
Mental Health Counselor
—
OK
171M00000X
Case Manager/Care Coordinator
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100742400B
—
OK
05
—
100742400F
—
OK
Enumeration date
03/07/2007
Last updated
10/12/2011
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