Provider Demographics
NPI:1346083656
Name:ULRICH, MADISON LEIGH (MA, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4817
Mailing Address - Country:US
Mailing Address - Phone:218-556-6004
Mailing Address - Fax:
Practice Address - Street 1:532 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4817
Practice Address - Country:US
Practice Address - Phone:218-556-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23857101YM0800X
MN2969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health