Provider Demographics
NPI:1538456231
Name:MADDOX, ROBERT PAUL II (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:MADDOX
Suffix:II
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 S KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4097
Mailing Address - Country:US
Mailing Address - Phone:573-587-1652
Mailing Address - Fax:
Practice Address - Street 1:800 WERNER CT STE 235
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1361
Practice Address - Country:US
Practice Address - Phone:573-587-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014540101YP2500X
WYLPC-1829101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional