Provider Demographics
NPI:1578304945
Name:ANDERTON, MADISON HALE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:HALE
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:HALE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22414 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2218
Mailing Address - Country:US
Mailing Address - Phone:346-307-4778
Mailing Address - Fax:
Practice Address - Street 1:22414 BRIDGEHAVEN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2218
Practice Address - Country:US
Practice Address - Phone:346-307-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110597104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker