MEDICARE: MADISON ELLIOTT LPC, LMFT

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	106H00000X	Marriage & Family Therapist	205104	TX
2	101YM0800X	Mental Health Counselor	93806	TX

General Provider Information

NPI Number	:	1710839600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ELLIOTT LPC, LMFT

Provider Business Mailing Address
First Line	:	10704 DUSTY RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-1956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 W MAGNOLIA AVE STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-8801
Country	:	US
Telephone Number	:	817-870-1087
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/25/2026

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