Provider Demographics
NPI:1609406941
Name:THE M.A.D. THERAPY, PLLC
Entity Type:Organization
Organization Name:THE M.A.D. THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:SKINNER
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:563-726-4750
Mailing Address - Street 1:2435 KIMBERLY RD STE 270
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3509
Mailing Address - Country:US
Mailing Address - Phone:563-726-4750
Mailing Address - Fax:563-396-2060
Practice Address - Street 1:2435 KIMBERLY RD STE 270
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-726-4750
Practice Address - Fax:563-396-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty