Healthcare Provider Details

I. General information

NPI: 1629760590
Provider Name (Legal Business Name): MADISON CONRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 ELDORADO PKWY STE 227
MCKINNEY TX
75070-6198
US

IV. Provider business mailing address

6401 ELDORADO PKWY STE 227
MCKINNEY TX
75070-6198
US

V. Phone/Fax

Practice location:
  • Phone: 469-712-5481
  • Fax: 214-856-3375
Mailing address:
  • Phone: 469-712-5481
  • Fax: 214-856-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: