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NPI Code Detail

MEDICARE: CLAIRE CONERLY MADDEN CIT

MEDICARE: CLAIRE CONERLY MADDEN CIT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor3340LA

General Provider Information

NPI Number : 1316457971
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE CONERLY MADDEN CIT
Provider Business Mailing Address
First Line : 2000 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2002
Country : US
Telephone Number : 318-222-8511
Fax Number : 318-222-3273
Provider Business Practice Location Address
First Line : 2000 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2002
Country : US
Telephone Number : 318-222-8511
Fax Number : 318-222-3273
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2017
Last Update Date : 10/09/2017

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