Provider Demographics
NPI:1356914527
Name:MADEN, KHALI (LMFT)
Entity type:Individual
Prefix:
First Name:KHALI
Middle Name:
Last Name:MADEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MIRONA ROAD EXT STE 3
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5385
Mailing Address - Country:US
Mailing Address - Phone:603-600-8533
Mailing Address - Fax:
Practice Address - Street 1:30 MIRONA ROAD EXT STE 3
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5385
Practice Address - Country:US
Practice Address - Phone:603-600-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health