Provider Demographics
NPI:1437768264
Name:MADDUX, REBECCA MCLAURIN (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MCLAURIN
Last Name:MADDUX
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:LAURIN
Other - Middle Name:
Other - Last Name:MADDUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:3788 MIMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6941
Mailing Address - Country:US
Mailing Address - Phone:901-336-6902
Mailing Address - Fax:
Practice Address - Street 1:4937 WILLIAM ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4237
Practice Address - Country:US
Practice Address - Phone:901-530-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6258101YM0800X
TX82094101YM0800X
TN2536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health