Organization
MADRE BAY CONSULTING AND PSYCHOLOGICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHA N SARGEANT PHD (OWNER)
(956) 299-6107
Entity
Organization
Contact information
Practice address
215 E QUEEN ISABELLA BLVD STE 102B, PORT ISABEL, TX 78578-2434
(956) 299-6107
(956) 299-6107
Mailing address
922 N SHORE DR, PORT ISABEL, TX 78578-4633
(956) 299-6107
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
07392
TX
103TA0400X
Addiction (Substance Use Disorder) Psychologist
07392
TX
103TB0200X
Cognitive & Behavioral Psychologist
07392
TX
103TC0700X
Clinical Psychologist
Primary
07392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362234201
—
TX
01
—
P01804306
RAILROAD MEDICARE
TX
Enumeration date
06/30/2017
Last updated
06/30/2017
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