Provider Demographics
NPI:1669206538
Name:MADDEN, KEVIN GINARD JR (CPRS, QMHS, CM)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GINARD
Last Name:MADDEN
Suffix:JR
Gender:M
Credentials:CPRS, QMHS, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MACANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9336
Mailing Address - Country:US
Mailing Address - Phone:614-743-9420
Mailing Address - Fax:
Practice Address - Street 1:273 S 3RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5133
Practice Address - Country:US
Practice Address - Phone:614-653-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
OHAPS.005588175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health