Healthcare Provider Details

I. General information

NPI: 1720750508
Provider Name (Legal Business Name): MADISON MCELROY P-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 GLENWOOD DR STE 1
COLUMBUS MS
39705-1596
US

IV. Provider business mailing address

846 BUCK EGGER RD
CALEDONIA MS
39740-9413
US

V. Phone/Fax

Practice location:
  • Phone: 601-513-2836
  • Fax:
Mailing address:
  • Phone: 601-513-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP-1328
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: