Provider Demographics
NPI:1063218246
Name:CLASGENS, MACKENZIE DIANE
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:DIANE
Last Name:CLASGENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3200
Mailing Address - Country:US
Mailing Address - Phone:210-870-8562
Mailing Address - Fax:
Practice Address - Street 1:508 PAT BOOKER RD # 422
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4434
Practice Address - Country:US
Practice Address - Phone:726-230-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician