Provider Demographics
NPI:1245207331
Name:MADISON, CATHE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHE
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 S REDWOOD RD
Mailing Address - Street 2:SUITE #15
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5322
Mailing Address - Country:US
Mailing Address - Phone:801-281-4084
Mailing Address - Fax:801-281-4083
Practice Address - Street 1:5691 S REDWOOD RD
Practice Address - Street 2:SUITE #15
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5322
Practice Address - Country:US
Practice Address - Phone:801-281-4084
Practice Address - Fax:801-281-4083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5388935-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health