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General NPI Number Information
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NPI Number | 1538456231
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Entity Type | Individual
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Provider Name | ROBERT PAUL MADDOX II PH.D., LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 800 WERNER CT STE 235
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City | CASPER
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State | WY
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Zip | 82601-1361
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Country | US
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Telephone | 573-587-1652
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 S KENWOOD ST
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City | CASPER
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State | WY
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Zip | 82601-4097
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Country | US
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Telephone | 573-587-1652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2011014540
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1829
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License Number State | WY
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