Provider Demographics
NPI:1316095961
Name:MADSEN, TERRENCE R (MA)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:R
Last Name:MADSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1105 MEMORIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2177
Mailing Address - Country:US
Mailing Address - Phone:903-337-0343
Mailing Address - Fax:903-337-0526
Practice Address - Street 1:1105 MEMORIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2177
Practice Address - Country:US
Practice Address - Phone:903-337-0343
Practice Address - Fax:903-337-0526
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional