Provider Demographics
NPI:1376421602
Name:KEITH, MADELINE (LPC- ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPC- ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10664 LAKE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2807
Mailing Address - Country:US
Mailing Address - Phone:228-217-5065
Mailing Address - Fax:
Practice Address - Street 1:5944 LUTHER LN # 470
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5942
Practice Address - Country:US
Practice Address - Phone:228-217-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98875101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty