MEDICARE: MARIAH MADDOX

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	106S00000X	Behavior Technician		LA

General Provider Information

NPI Number	:	1588522965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH MADDOX

Provider Business Mailing Address
First Line	:	900 EMERALD FOREST BLVD APT 6208
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 EMERALD FOREST BLVD APT 6208
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5968
Country	:	US
Telephone Number	:	985-338-1431
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ MARIAH MADDOX ” Practice Location

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