Provider Demographics
NPI:1083391866
Name:GARNER, MADELYN W (LPA, LSSP, ASDCS)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:W
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPA, LSSP, ASDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15533 FINISTERE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6444
Mailing Address - Country:US
Mailing Address - Phone:361-244-3811
Mailing Address - Fax:
Practice Address - Street 1:15533 FINISTERE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6444
Practice Address - Country:US
Practice Address - Phone:361-244-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34460103TC0700X
TX34325103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool