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General NPI Number Information
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NPI Number | 1306396841
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Entity Type | Organization
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Legal Business Name | MADDOX COUNSELING LLC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1609 SHERMAN AVE STE 312
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City | EVANSTON
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State | IL
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Zip | 60201-5013
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Country | US
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Telephone | 847-254-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 SHERMAN AVE STE 312
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City | EVANSTON
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State | IL
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Zip | 60201-5013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ROBIN MADDOX
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Credential |
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Telephone | 847-254-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001083
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License Number State | IL
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