MEDICARE: LAKIN R MADDOX LPC

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	101YP2500X	Professional Counselor	P2402009	AR

General Provider Information

NPI Number	:	1881031748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKIN R MADDOX LPC

Provider Business Mailing Address
First Line	:	910 S ROGERS ST STE I
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-4331
Country	:	US
Telephone Number	:	479-335-5747
Fax Number	:	479-957-9083

Provider Business Practice Location Address
First Line	:	910 S ROGERS ST STE I
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-4331
Country	:	US
Telephone Number	:	479-335-5747
Fax Number	:	479-957-9083

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	04/02/2024

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Directions to “ LAKIN R MADDOX LPC” Practice Location

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