Provider Demographics
NPI:1851048474
Name:MINOR, MADELINE ELAINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELAINE
Last Name:MINOR
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 1:4001 FANNIN ST APT 4131
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4075
Mailing Address - Country:US
Mailing Address - Phone:832-603-0325
Mailing Address - Fax:
Practice Address - Street 1:719 SAWDUST RD STE 309
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2900
Practice Address - Country:US
Practice Address - Phone:833-511-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional