=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598635187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMILY MADDOX PROFESSIONAL CLINICAL COUNSELOR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2025
-----------------------------------------------------
Last Update Date | 11/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S MILLER ST STE 103
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-5248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-221-4169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1359 SCOTT LEE DR
-----------------------------------------------------
City | OCEANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93445-9155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EMILY MADDOX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-221-4169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------