Provider Demographics
NPI:1003932419
Name:SAN MARCOS CISD
Entity Type:Organization
Organization Name:SAN MARCOS CISD
Other - Org Name:SCHOOL-AGE PARENTING PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:HENDERSON
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-393-6323
Mailing Address - Street 1:540 STAPLES RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-1406
Mailing Address - Country:US
Mailing Address - Phone:512-393-6323
Mailing Address - Fax:512-393-6338
Practice Address - Street 1:540 STAPLES RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-1406
Practice Address - Country:US
Practice Address - Phone:512-393-6323
Practice Address - Fax:512-393-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS19322251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1085771Medicaid