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General NPI Number Information
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NPI Number | 1164692034
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Entity Type | Organization
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Legal Business Name | MADISON COUNSELING SERVICES
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 1050 REGENT ST SUITE 204
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City | MADISON
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State | WI
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Zip | 53715
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Country | US
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Telephone | 608-257-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 REGENT ST SUITE 204
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City | MADISON
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State | WI
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Zip | 53715
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Country | US
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Telephone | 608-257-0800
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. TRACY LEWIS
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Credential | LCSW
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Telephone | 608-257-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1008
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1105123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3047
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License Number State | WI
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