Provider Demographics
NPI:1083968192
Name:MADDEN, DANIEL J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 KEMP BLVD
Mailing Address - Street 2:STE 710
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308
Mailing Address - Country:US
Mailing Address - Phone:940-692-9745
Mailing Address - Fax:940-692-9722
Practice Address - Street 1:4245 KEMP BLVD
Practice Address - Street 2:STE 710
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2824
Practice Address - Country:US
Practice Address - Phone:940-692-9745
Practice Address - Fax:940-692-9722
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional