Provider Demographics
NPI:1043257884
Name:MACY KINZEL, PH.D., P.C.
Entity type:Organization
Organization Name:MACY KINZEL, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-855-2710
Mailing Address - Street 1:3434 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1720
Mailing Address - Country:US
Mailing Address - Phone:361-855-2710
Mailing Address - Fax:361-855-4204
Practice Address - Street 1:3434 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1720
Practice Address - Country:US
Practice Address - Phone:361-855-2710
Practice Address - Fax:361-855-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23357103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032744701Medicaid
TX032744701Medicaid