Provider Demographics
NPI:1871701656
Name:KAREN W. MALM, PH.D., P.C.
Entity type:Organization
Organization Name:KAREN W. MALM, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WHEELOCK
Authorized Official - Last Name:MALM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-599-0924
Mailing Address - Street 1:PO BOX 982678
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-2678
Mailing Address - Country:US
Mailing Address - Phone:801-599-0924
Mailing Address - Fax:435-649-7266
Practice Address - Street 1:4018 RASMUSSEN RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4705
Practice Address - Country:US
Practice Address - Phone:801-599-0924
Practice Address - Fax:435-649-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116826-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT101527079003Medicaid