Provider Demographics
NPI:1598103467
Name:MADSON, BRIAN (BA, LADC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:MADSON
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 6TH ST E
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1654
Mailing Address - Country:US
Mailing Address - Phone:651-221-0334
Mailing Address - Fax:
Practice Address - Street 1:287 6TH ST E
Practice Address - Street 2:SUITE #300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1654
Practice Address - Country:US
Practice Address - Phone:651-221-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)