Provider Demographics
NPI:1356989206
Name:ROBERTSON, MADISON SHEPARD (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SHEPARD
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 MURRAY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3891
Mailing Address - Country:US
Mailing Address - Phone:901-295-4741
Mailing Address - Fax:
Practice Address - Street 1:5545 MURRAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3891
Practice Address - Country:US
Practice Address - Phone:901-295-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4667101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health