Provider Demographics
NPI:1356730345
Name:MAGELLAN
Entity type:Organization
Organization Name:MAGELLAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATION SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-387-5373
Mailing Address - Street 1:1200 BARTON HILLS DR APT 260
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1913
Mailing Address - Country:US
Mailing Address - Phone:254-371-6844
Mailing Address - Fax:
Practice Address - Street 1:1200 BARTON HILLS DR APT 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1913
Practice Address - Country:US
Practice Address - Phone:254-371-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08078273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08078OtherLICENSED CLINICAL SOCIAL WORKER
TX10780OtherLICENSED CHEMICAL DEPENDENCY COUNSELOR