Individual
BRUCE EDWARD MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
3593 MEDINA RD # 181, MEDINA, OH 44256-8182
(330) 401-5244
Mailing address
2121 KEVIN CT NE, NEW PHILADELPHIA, OH 44663-9446
(330) 401-5244
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7105
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3218695674
PPOM
MI
01
—
371354712
MAGELLAN
MI
01
—
382695674
VALUE OPTIONS
MI
01
—
680H215160
BC/BS OF MICHIGAN
MI
Enumeration date
07/19/2007
Last updated
03/29/2022
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