Provider Demographics
NPI:1093354177
Name:HANDKINS, MARIE NOELLE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:NOELLE
Last Name:HANDKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGTOWN WAY APT 315A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7145
Mailing Address - Country:US
Mailing Address - Phone:512-230-2741
Mailing Address - Fax:
Practice Address - Street 1:102 WESTLAKE DR STE 105
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-9818
Practice Address - Country:US
Practice Address - Phone:737-843-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39950728106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician