Provider Demographics
NPI:1215766001
Name:VERNOOY MADDEN, TONYA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:VERNOOY MADDEN
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4934
Mailing Address - Country:US
Mailing Address - Phone:972-590-8030
Mailing Address - Fax:
Practice Address - Street 1:211 S TYLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4934
Practice Address - Country:US
Practice Address - Phone:972-590-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX90639OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE