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NPI Code Detail

MEDICARE: MARISSA DANIELLE MADDEN

MEDICARE: MARISSA DANIELLE MADDEN
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1295077147
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA DANIELLE MADDEN
Provider Business Mailing Address
First Line : 1308 CRADDUCK RD
Second Line :
City : ADA
State : OK
Zip : 74820-8442
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 W 4TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-3411
Country : US
Telephone Number : 580-257-2444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2013
Last Update Date : 10/03/2022

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Directions to “ MARISSA DANIELLE MADDEN ” Practice Location

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