Provider Demographics
NPI:1437419116
Name:MADSON, AMY T (LMFT FAMI)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:MADSON
Suffix:
Gender:F
Credentials:LMFT FAMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 INDUSTRIAL PARK BLVD STE B50
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3905
Mailing Address - Country:US
Mailing Address - Phone:612-216-0984
Mailing Address - Fax:612-216-0984
Practice Address - Street 1:12800 INDUSTRIAL PARK BLVD STE B50
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3905
Practice Address - Country:US
Practice Address - Phone:612-219-1449
Practice Address - Fax:612-216-0984
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist