Healthcare Provider Details

I. General information

NPI: 1700672391
Provider Name (Legal Business Name): MADISON MAGNUS MS, LMHC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 BOYETTE RD # 443
RIVERVIEW FL
33569-5533
US

IV. Provider business mailing address

11705 BOYETTE RD # 443
RIVERVIEW FL
33569-5533
US

V. Phone/Fax

Practice location:
  • Phone: 614-441-1055
  • Fax:
Mailing address:
  • Phone: 614-441-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25442
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: