Malcolm, Lamont Rudolph

Malcolm, Lamont Rudolph is an individual health care provider with primary practice located at 2701 N Oklahoma Ave , Oklahoma City OK 73105-2724. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Other Service Providers / Case Manager/Care Coordinator. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Malcolm, Lamont Rudolph can be contacted via phone (405) 528-8686.

Contact Information

Primary practice address
2701 N Oklahoma Ave Oklahoma City OK 73105-2724
Phone: (405) 528-8686
Fax: (405) 528-8692
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X Oklahoma
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 698 Oklahoma
Other Service Providers / Case Manager/Care Coordinator 171M00000X Oklahoma

Profile Details

NPI number 1528198561
LBN Legal business name Malcolm, Lamont Rudolph
Credentials LADC, CBHCM
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2007
Last updated Oct 12th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528198561 NPPES
Oklahoma MEDICAID 100742400B
Oklahoma MEDICAID 100742400F

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