Provider Demographics
NPI:1609582014
Name:GARNER, MADISON PAIGE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 AUDELIA RD APT 723
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5687
Mailing Address - Country:US
Mailing Address - Phone:214-596-8563
Mailing Address - Fax:
Practice Address - Street 1:11620 AUDELIA RD APT 723
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5687
Practice Address - Country:US
Practice Address - Phone:214-596-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician