Individual
LOUIS MALLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
STATE HWY SR 264 AND US 191, GANADO, AZ 86505-0457
(928) 755-4500
Mailing address
PO BOX 457, GANADO, AZ 86505-0457
(928) 755-4500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC463
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH0150
—
AK
Enumeration date
04/18/2007
Last updated
09/16/2011
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