NPI Number: 1780970715
Health Care Provider/Practitioner: AMBER RAE MADUME BA, BS, BHRS, MS
Information about “1780970715” NPI (AMBER RAE MADUME BA, BS, BHRS, MS)
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<?xml version="1.0" encoding="UTF-8"?>
<Npi>
<NPI>
1780970715
</NPI>
<EntityType>
Individual
</EntityType>
<ReplacementNPI/>
<EIN/>
<IsSoleProprietor>
N
</IsSoleProprietor>
<IsOrgSubpart/>
<ParentOrgLBN/>
<ParentOrgTIN/>
<OrgName/>
<LastName>
MADUME
</LastName>
<FirstName>
AMBER
</FirstName>
<MiddleName>
RAE
</MiddleName>
<NamePrefix/>
<NameSuffix/>
<Credential>
BA, BS, BHRS, MS
</Credential>
<OtherOrgName/>
<OtherOrgNameTypeCode/>
<OtherLastName>
WOOTEN
</OtherLastName>
<OtherFirstName>
AMBER
</OtherFirstName>
<OtherMiddleName>
RAE
</OtherMiddleName>
<OtherNamePrefix/>
<OtherNameSuffix/>
<OtherCredential>
BA, BS, BHRS
</OtherCredential>
<OtherLastNameTypeCode>
1
</OtherLastNameTypeCode>
<FirstLineMailingAddress>
202 LACEY LN
</FirstLineMailingAddress>
<SecondLineMailingAddress>
UNIT B
</SecondLineMailingAddress>
<MailingAddressCityName>
POTEAU
</MailingAddressCityName>
<MailingAddressStateName>
OK
</MailingAddressStateName>
<MailingAddressPostalCode>
74953-5551
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber/>
<MailingAddressFaxNumber/>
<FirstLinePracticeLocationAddress>
6040 EARLE BROWN DR STE 100
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress/>
<PracticeLocationAddressCityName>
BROOKLYN CENTER
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
MN
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
55430-2561
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
651-313-8080
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber/>
<EnumerationDate>
06/28/2011
</EnumerationDate>
<LastUpdateDate>
03/21/2024
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode>
F
</GenderCode>
<Gender>
Female
</Gender>
<AuthorizedOfficialLastName/>
<AuthorizedOfficialFirstName/>
<AuthorizedOfficialMiddleName/>
<AuthorizedOfficialTitle/>
<AuthorizedOfficialNamePrefix/>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential/>
<AuthorizedOfficialTelephoneNumber/>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
225C00000X
</TaxonomyCode>
<TaxonomyName>
Rehabilitation Counselor
</TaxonomyName>
<LicenseNumber/>
<LicenseNumberStateCode/>
<PrimaryTaxonomySwitch>
N
</PrimaryTaxonomySwitch>
</Taxonomy>
<Taxonomy>
<TaxonomyCode>
101YM0800X
</TaxonomyCode>
<TaxonomyName>
Mental Health Counselor
</TaxonomyName>
<LicenseNumber>
4232
</LicenseNumber>
<LicenseNumberStateCode>
MN
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups/>
</Npi>
<?xml version="1.0" encoding="UTF-8"?>
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" elementFormDefault="qualified" attributeFormDefault="unqualified">
<xs:element name="Npi">
<xs:complexType>
<xs:sequence>
<xs:element name="NPI" type="xs:int"></xs:element>
<xs:element name="EntityType" type="xs:string"></xs:element>
<xs:element name="ReplacementNPI"></xs:element>
<xs:element name="EIN"></xs:element>
<xs:element name="IsSoleProprietor" type="xs:string"></xs:element>
<xs:element name="IsOrgSubpart"></xs:element>
<xs:element name="ParentOrgLBN"></xs:element>
<xs:element name="ParentOrgTIN"></xs:element>
<xs:element name="OrgName"></xs:element>
<xs:element name="LastName" type="xs:string"></xs:element>
<xs:element name="FirstName" type="xs:string"></xs:element>
<xs:element name="MiddleName"></xs:element>
<xs:element name="NamePrefix" type="xs:string"></xs:element>
<xs:element name="NameSuffix"></xs:element>
<xs:element name="Credential" type="xs:string"></xs:element>
<xs:element name="OtherOrgName"></xs:element>
<xs:element name="OtherOrgNameTypeCode"></xs:element>
<xs:element name="OtherLastName"></xs:element>
<xs:element name="OtherFirstName"></xs:element>
<xs:element name="OtherMiddleName"></xs:element>
<xs:element name="OtherNamePrefix"></xs:element>
<xs:element name="OtherNameSuffix"></xs:element>
<xs:element name="OtherCredential"></xs:element>
<xs:element name="OtherLastNameTypeCode"></xs:element>
<xs:element name="FirstLineMailingAddress" type="xs:string"></xs:element>
<xs:element name="SecondLineMailingAddress"></xs:element>
<xs:element name="MailingAddressCityName" type="xs:string"></xs:element>
<xs:element name="MailingAddressStateName" type="xs:string"></xs:element>
<xs:element name="MailingAddressPostalCode" type="xs:string"></xs:element>
<xs:element name="MailingAddressCountryCode" type="xs:string"></xs:element>
<xs:element name="MailingAddressTelephoneNumber" type="xs:string"></xs:element>
<xs:element name="MailingAddressFaxNumber"></xs:element>
<xs:element name="FirstLinePracticeLocationAddress" type="xs:string"></xs:element>
<xs:element name="SecondLinePracticeLocationAddress" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressCityName" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressStateName" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressPostalCode" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressCountryCode" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressTelephoneNumber" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressFaxNumber"></xs:element>
<xs:element name="EnumerationDate" type="xs:string"></xs:element>
<xs:element name="LastUpdateDate" type="xs:string"></xs:element>
<xs:element name="NPIDeactivationReasonCode"></xs:element>
<xs:element name="NPIDeactivationReason"></xs:element>
<xs:element name="NPIDeactivationDate"></xs:element>
<xs:element name="NPIReactivationDate"></xs:element>
<xs:element name="GenderCode" type="xs:string"></xs:element>
<xs:element name="Gender" type="xs:string"></xs:element>
<xs:element name="AuthorizedOfficialLastName"></xs:element>
<xs:element name="AuthorizedOfficialFirstName"></xs:element>
<xs:element name="AuthorizedOfficialMiddleName"></xs:element>
<xs:element name="AuthorizedOfficialTitle"></xs:element>
<xs:element name="AuthorizedOfficialNamePrefix"></xs:element>
<xs:element name="AuthorizedOfficialNameSuffix"></xs:element>
<xs:element name="AuthorizedOfficialCredential"></xs:element>
<xs:element name="AuthorizedOfficialTelephoneNumber"></xs:element>
<xs:element name="Taxonomies">
<xs:complexType>
<xs:sequence>
<xs:element name="Taxonomy" maxOccurs="unbounded">
<xs:complexType>
<xs:sequence>
<xs:element name="TaxonomyCode" type="xs:string"></xs:element>
<xs:element name="TaxonomyName" type="xs:string"></xs:element>
<xs:element name="LicenseNumber" type="xs:string"></xs:element>
<xs:element name="LicenseNumberStateCode" type="xs:string"></xs:element>
<xs:element name="PrimaryTaxonomySwitch" type="xs:string"></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name="OtherIdentifiers">
<xs:complexType>
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<xs:element name="OtherIdentifier" maxOccurs="unbounded">
<xs:complexType>
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<xs:element name="OtherIdentifierName" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierType" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierState" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierIssuer"></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name="HealthcareProviderTaxonomyGroups"></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:schema>