Provider Demographics
NPI:1437792272
Name:MADSEN, BRIAN LEROY (COUNSELOR TECH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEROY
Last Name:MADSEN
Suffix:
Gender:M
Credentials:COUNSELOR TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 GAMBELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4664
Mailing Address - Country:US
Mailing Address - Phone:907-333-4343
Mailing Address - Fax:907-333-4343
Practice Address - Street 1:1231 GAMBELL ST STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4664
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4343
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist