Provider Demographics
NPI:1053135186
Name:EARL, MADELINE ALEXANDRA (LPCC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ALEXANDRA
Last Name:EARL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 HOLLY AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4455
Mailing Address - Country:US
Mailing Address - Phone:423-732-1567
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2039
Practice Address - Country:US
Practice Address - Phone:303-691-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health