Provider Demographics
NPI:1104492610
Name:MEADOWS, MADISON RAE (LPC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:RAE
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:RAE
Other - Last Name:JUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 RIO GRANDE ST APT 231
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2792
Mailing Address - Country:US
Mailing Address - Phone:512-674-5616
Mailing Address - Fax:
Practice Address - Street 1:1430 COLLIER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2911
Practice Address - Country:US
Practice Address - Phone:737-243-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77757OtherLICENSED PROFESSIONAL COUNSELOR