Provider Demographics
NPI:1114448925
Name:MADRE BAY CONSULTING AND PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MADRE BAY CONSULTING AND PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SARGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:956-299-6107
Mailing Address - Street 1:922 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-4633
Mailing Address - Country:US
Mailing Address - Phone:956-299-6107
Mailing Address - Fax:
Practice Address - Street 1:215 E QUEEN ISABELLA BLVD STE 102B
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2434
Practice Address - Country:US
Practice Address - Phone:956-299-6107
Practice Address - Fax:956-299-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07392103T00000X, 103TA0400X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362234201Medicaid
TXP01804306OtherRAILROAD MEDICARE