Provider Demographics
NPI:1437802030
Name:WILLIAM B. MADDOX PA
Entity Type:Organization
Organization Name:WILLIAM B. MADDOX PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-970-5097
Mailing Address - Street 1:910 S ROGERS ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4331
Mailing Address - Country:US
Mailing Address - Phone:479-335-5747
Mailing Address - Fax:479-957-9083
Practice Address - Street 1:910 S ROGERS ST STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4331
Practice Address - Country:US
Practice Address - Phone:479-335-5747
Practice Address - Fax:479-957-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty