Healthcare Provider Details

I. General information

NPI: 1609406941
Provider Name (Legal Business Name): THE M.A.D. THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 KIMBERLY RD STE 270
BETTENDORF IA
52722-3509
US

IV. Provider business mailing address

2435 KIMBERLY RD STE 270
BETTENDORF IA
52722-3509
US

V. Phone/Fax

Practice location:
  • Phone: 563-726-4750
  • Fax: 563-396-2060
Mailing address:
  • Phone: 563-726-4750
  • Fax: 563-396-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA SKINNER WALSH
Title or Position: OWNER AND MENTAL HEALTH COUNSELOR
Credential: MS, LMHC
Phone: 563-726-4750