Provider Demographics
NPI:1801573886
Name:MADDUX, GARY LEE JR (MA, LPC-A)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:MADDUX
Suffix:JR
Gender:M
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8030
Mailing Address - Country:US
Mailing Address - Phone:540-842-8394
Mailing Address - Fax:
Practice Address - Street 1:9153 BELSHIRE DR STE 130
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-7643
Practice Address - Country:US
Practice Address - Phone:214-865-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91610101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional