MEDICARE: MRS. MADELEINE CLEMENT SAVAGE LPC

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	63355	TX

General Provider Information

NPI Number	:	1386348928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELEINE CLEMENT SAVAGE LPC

Provider Business Mailing Address
First Line	:	2717 WILLING AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3035
Country	:	US
Telephone Number	:	817-845-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 WILLING AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3035
Country	:	US
Telephone Number	:	817-845-3435
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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