Provider Demographics
NPI:1134126352
Name:ALFORD, MADELINE (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 SHERIDAN LN
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2645
Mailing Address - Country:US
Mailing Address - Phone:409-982-6550
Mailing Address - Fax:
Practice Address - Street 1:85 IH 10 N
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2539
Practice Address - Country:US
Practice Address - Phone:409-839-8233
Practice Address - Fax:409-839-4489
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YP2500XOtherTAXONOMY CODE