Provider Demographics
NPI:1356082267
Name:THACKER, MADISON ANN
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:ANN
Last Name:THACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 ACKLEN AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3514
Mailing Address - Country:US
Mailing Address - Phone:214-773-0096
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S STE 410
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4350
Practice Address - Country:US
Practice Address - Phone:615-492-6700
Practice Address - Fax:615-492-6710
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health