Individual
MARTIN MOSE MALOUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS CACIII
Contact information
Practice address
1004 S CARBON AVE, TRINIDAD, CO 81082-3664
(719) 846-4481
Mailing address
PO BOX 533, TRINIDAD, CO 81082-0533
(719) 859-0483
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CACIII #6383
CO
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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