Provider Demographics
NPI:1669156535
Name:NUTT, MADELEINE ELIZABETH (LPC-A)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:ELIZABETH
Last Name:NUTT
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 LOUETTA RD # 955
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5155
Mailing Address - Country:US
Mailing Address - Phone:713-992-4710
Mailing Address - Fax:
Practice Address - Street 1:3201 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8302
Practice Address - Country:US
Practice Address - Phone:713-992-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional