MEDICARE: MADISON POWERS TAYLOR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	67788	TX

General Provider Information

NPI Number	:	1255073243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON POWERS TAYLOR LCSW

Provider Business Mailing Address
First Line	:	13760 NOEL RD STE 332
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-7336
Country	:	US
Telephone Number	:	469-904-0446
Fax Number	:

Provider Business Practice Location Address
First Line	:	13760 NOEL RD STE 332
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-7336
Country	:	US
Telephone Number	:	469-904-0446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2022
Last Update Date	:	06/10/2025

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