MEDICARE: MRS. DENISE MADISON M.S. MFT I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1154459261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE MADISON M.S. MFT I

Provider Business Mailing Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:	STE 1014
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2506
Country	:	US
Telephone Number	:	702-899-8212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N RANCHO DR STE 113
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3154
Country	:	US
Telephone Number	:	562-977-8603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	02/23/2021

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