| NPI | 1619968674 |
|---|---|
| Doing Business As | MADISON AVENUE PSYCHOLOGICAL SERVICES |
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL WUBBENHORST President Of Corporation 876-753-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-09-01 |