MEDICARE: MADELINE KEITH LPC- ASSOCIATE

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	98875	TX

General Provider Information

NPI Number	:	1376421602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE KEITH LPC- ASSOCIATE

Provider Business Mailing Address
First Line	:	10664 LAKE HAVEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2807
Country	:	US
Telephone Number	:	228-217-5065
Fax Number	:

Provider Business Practice Location Address
First Line	:	5944 LUTHER LN # 470
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5942
Country	:	US
Telephone Number	:	228-217-5065
Fax Number	:

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

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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