Provider Demographics
NPI:1861503856
Name:SOUCY, MARK D (PHD, RN, CNS-BC P/MH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SOUCY
Suffix:
Gender:M
Credentials:PHD, RN, CNS-BC P/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:DEPARTMENT OF FAMILY NURSING CARE MAIL CODE 7951
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-269-8651
Mailing Address - Fax:210-567-5822
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:DEPARTMENT OF FAMILY NURSING CARE MAIL CODE 7951
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-5893
Practice Address - Fax:210-567-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH022528-23-08363LP0808X
TX599005364SP0808X, 364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX890000755OtherMEDICARE RAILROAD PROVIDE
TXNP7250OtherBCBSTX PAR (SOLO)
TXSO085N754OtherBLUE SHIELD ID
TX8N3781OtherBCBS EXISTING PROVIDER #
TXSO085N754OtherBC/BS PROVIDER
TXSO085N754OtherBLUE SHIELD ID