Healthcare Provider Details

I. General information

NPI: 1770166456
Provider Name (Legal Business Name): MADISON LYNN HENZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON LYNN SEARS

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W THARPE ST
TALLAHASSEE FL
32303-5374
US

IV. Provider business mailing address

1000 W THARPE ST STE 9
TALLAHASSEE FL
32303-5300
US

V. Phone/Fax

Practice location:
  • Phone: 813-295-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW26528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: