Provider Demographics
NPI:1619631595
Name:THOMAS, MADELAINE JADE (LMSW)
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:JADE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GRACY FARMS LN APT 914
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2918
Mailing Address - Country:US
Mailing Address - Phone:817-313-2775
Mailing Address - Fax:
Practice Address - Street 1:4408 SPICEWOOD SPRINGS RD STE 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8504
Practice Address - Country:US
Practice Address - Phone:512-953-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105294101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor