Provider Demographics
NPI:1164674271
Name:MADDEN, DENNIS RAY (LPC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:RAY
Last Name:MADDEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 WINIFRED DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2003
Mailing Address - Country:US
Mailing Address - Phone:817-233-2974
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLLINS BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2457
Practice Address - Country:US
Practice Address - Phone:972-669-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional