Provider Demographics
NPI:1497045926
Name:CODY, KATHLEEN BRYAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BRYAN
Last Name:CODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-0016
Mailing Address - Country:US
Mailing Address - Phone:512-393-4084
Mailing Address - Fax:
Practice Address - Street 1:102 WHITETAIL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-9739
Practice Address - Country:US
Practice Address - Phone:512-393-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX099351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical