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General NPI Number Information
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NPI Number | 1952781809
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Entity Type | Individual
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Provider Name | CAROLYN L MADRY LPC, M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 2020 RAYBROOK ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7717
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Country | US
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Telephone | 414-520-2503
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Fax |
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Provider Business Mailing Address
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Address Line | 445 WASHINGTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4458
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Country | US
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Telephone | 414-520-2503
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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 | 6401016195
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License Number State | MI
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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 | 2555-226
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License Number State | WI
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