Healthcare Provider Details

I. General information

NPI: 1467145458
Provider Name (Legal Business Name): GABBY MADDIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE MADDIX-BURKE

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JACKSON ST W
BATTLE CREEK MI
49017-3542
US

IV. Provider business mailing address

6100 NEWPORT RD
PORTAGE MI
49002-9235
US

V. Phone/Fax

Practice location:
  • Phone: 269-251-1233
  • Fax:
Mailing address:
  • Phone: 269-488-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025081
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: