Provider Demographics
NPI:1962648493
Name:MADRIGAL, TABITHA JEAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:JEAN
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:JEAN
Other - Last Name:MADRIGAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1430 WILKINS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-237-9583
Mailing Address - Fax:307-265-7277
Practice Address - Street 1:1430 WILKINS CIRCLE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-237-9583
Practice Address - Fax:307-265-7277
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC 1430101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor