Healthcare Provider Details

I. General information

NPI: 1952162976
Provider Name (Legal Business Name): MADISON MORLEY LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E RANDOL MILL RD STE 100
ARLINGTON TX
76011-5800
US

IV. Provider business mailing address

PO BOX 121835
ARLINGTON TX
76012-7835
US

V. Phone/Fax

Practice location:
  • Phone: 855-579-5323
  • Fax:
Mailing address:
  • Phone: 855-579-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93477
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: