C h a p t e r

1

1TMHP and DSHS Contact Information

1.1 TMHP-CSHCN Services Program Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . 1-21.1.1 TMHP-CSHCN Contact Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21.1.2 TMHP-CSHCN Automated Inquiry System (AIS) . . . . . . . . . . . . . . . . . . . . . . . . . 1-21.1.3 TMHP Regional Representatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

1.2 DSHS-CSHCN Central and Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-31.2.1 Central Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-31.2.2 Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

1.2.2.1 Region 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-41.2.2.2 Region 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-41.2.2.3 Region 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-51.2.2.4 Region 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-61.2.2.5 Region 5 North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-81.2.2.6 Regions 5 South and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-91.2.2.7 Region 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-91.2.2.8 Region 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-101.2.2.9 Regions 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-111.2.2.10 Region 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12

1.3 DSHS Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14

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1.1 TMHP-CSHCN Services Program Contact Information

1.1.1 TMHP-CSHCN Contact CenterThe TMHP-CSHCN Contact Center is available Monday through Friday, 7 a.m. to 7 p.m., Central Time, and is the main point of contact for the CSHCN provider community. The toll-free telephone number is 1-800-568-2413.

1.1.2 TMHP-CSHCN Automated Inquiry System (AIS)Dial 1-800-568-2413 (toll-free) to access the TMHP-CSHCN Automated Inquiry System (AIS). The call is answered automatically. Follow the directions to access AIS and use the automated features to obtain information and services.

The TMHP-CSHCN AIS provides the following information and services through the use of a touch-tone telephone: claim status, patient eligibility, current weekly payment amount, faxed forms, and claim appeals.

The TMHP-CSHCN AIS is available 24 hours a day, 7 days a week for eligibility and claim status infor-mation. For all other information, the TMHP-CSHCN AIS is available from 7 a.m. until 7 p.m., Central Time, Monday through Friday. AIS offers 15 transactions per call.

Note: Press Star/Pound (*#) to repeat any information given. Press Star/Star (**) to begin again if an error was made. Press Zero and Pound (0#) at any time to repeat the main menu.

Full instructions on the use and benefits of the TMHP-CSHCN AIS can be found in the Automated Inquiry System (AIS) User’s Guide available on the TMHP website at www.tmhp.com, by calling the TMHP-CSHCN Contact Center at 1-800-568-2413, or in Appendix A, “CSHCN Automated Inquiry System (AIS) User’s Guide” of this manual.

Important: Due to the implementation of recent improvements in the system, the User Guide as printed in Appendix A of this manual may be out of date.The TMHP website or the TMHP-CSHCN Contact Center are better sources for the most recent version of the Automated Inquiry System (AIS) User Guide.

1.1.3 TMHP Regional RepresentativesTMHP provider relations representatives provide a variety of services designed to inform and educate the provider community about the CSHCN Services Program policies and claims filing procedures. Technical support and training are also provided for TDHconnect software users. Provider relations representatives assist providers through telephone contact, onsite visits, and scheduled workshops. The table below indicates the TMHP provider relations representatives and the areas they serve. Additional information, including a regional listing by county and workshop infor-mation, is available on the TMHP website at www.tmhp.com/Providers/default.aspx. Click on the TMHP Provider Services Representatives link listed under Provider Resources on the TMHP website.

Territory Regional Area Provider RepresentativeTelephone Number

1 Amarillo, Childress, and Lubbock Elizabeth Ramirez 1-512-506-6217

2 Midland, Odessa, and San Angelo Diane Molina 1-512-506-3423

3 Alpine, El Paso, and Van Horn Isaac Romero 1-512-506-3530

4 Del Rio, Eagle Pass, and Laredo Francisca Sanchez 1-512-506-7271

TMHP and DSHS Contact Information

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1.2 DSHS-CSHCN Central and Regional Offices

1.2.1 Central OfficeThe central and regional offices of the CSHCN Services Program are administratively located within the Division for Family & Community Health Services, Specialized Health Services Section, Purchased Health Services Unit, at the Department of State Health Services (DSHS). Regular office hours are 8 a.m. to 5 p.m., Central Time, Monday through Friday.

TMHP is the claims administrator, and questions concerning provider enrollment, benefits or coverage, claims processing, and authorizations or prior authorizations should be directed to TMHP. DSHS-CSHCN welcomes other provider comments and suggestions. Contact DSHS-CSHCN using the following information:

• Telephone toll-free at 1-800-252-8023 (may be used only in Texas) or the Austin local number is 1-512-458-7111, Ext. 3099

• Fax to DSHS-CSHCN at 1-512-458-7417

• Send email to cshcn@dshs.state.tx.us

5 Brownsville, Harlingen, and McAllen

Cynthia Gonzales 1-512-506-7991

6 Abilene and Wichita Falls Matthew Cogburn 1-512-506-7095

7 Brady, Brownwood, Hospitals in Travis County, Round Rock, and Waco

Andrea Daniell 1-512-506-7600

8 Austin, Bryan, College Station, and Wharton

Will McGowan 1-512-506-3526

9 San Antonio and Kerrville Sue Lamb 1-512-506-3422

10 San Antonio, Corpus Christi, and Victoria

Jill Ray 1-512-506-3554

11 Cleburne, Denton, and Fort Worth Rita Martinez 1-512-506-7990

12 Dallas, Corsicana, and Groesbeck Sandra Peterson 1-512-506-3552

13 Dallas and Whitesboro Olga Fletcher 1-512-506-3578

14 Tyler, Texarkana, and Paris Trilby Foster 1-512-506-7053

15 Beaumont and Lufkin Gene Allred 1-512-506-3425

16 Houston and Conroe Linda Wood 1-512-506-7682

17 Houston and Katy Rachelle Moore 1-512-506-3447

18 Galveston and Matagorda John Miller 1-512-506-3586

19 Houston Stephen Hirschfelder 1-512-506-3446

Territory Regional Area Provider RepresentativeTelephone Number

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• Mail to the following address:

Department of State Health ServicesCSHCN Services Program, MC-1938

ATTN: Provider Relations1100 West 49th StreetAustin, TX 78756-3179

Additional information about the CSHCN Services Program is available online at www.dshs.state.tx.us/cshcn.

1.2.2 Regional OfficesCase management and client eligibility services are provided by a statewide network of regionally based social service program consultants and include the following activities:

• Coordination of medical services

• Linkage to available resources

• Acting as a liaison among the child, family, and caregivers

• Management of institutional services, insurance carriers, and other services required for the improved well-being of the child and family

Refer to: Appendix B, “Acronyms and Initials Dictionary” for definitions of the abbreviated academic degrees listed in the following tables.

1.2.2.1 Region 1

1.2.2.2 Region 2

Canyon Regional Sub-Office (Canyon)Department of State Health Services Health Service Region 1 300 Victory Drive PO Box 60968 WTAMU Canyon, TX 79016

Telephone: 1-806-655-7151, Ext. 223Fax: 1-806-655-0820

Director of Social Work Services:Pat Greenwood, MSSW, LMSW

Medical Case Managers:Susan Stokes, MEd, LBSW

Dina Herrera, BSSW, LBSW

Eva Peña, BSSW, LBSW

Suzy Klein, BA, LMSW

Eligibility and Support: Juanita Diaz

Kathie Robinson

Lubbock Regional Office1109 Kemper Lubbock, TX 79403

Telephone: 1-806-744-3577Fax: 1-806-767-0403

Medical Case Managers:Judy Lara, BSSW, LBSW

Rebecca Williams, BA, LBSW

Eligibility and Support: Regina Luna

Abilene Office4601 South First Street, Suite L Abilene, TX 79605

Telephone: 1-325-795-5869Fax: 1-325-795-5894

Medical Case Manager:Vacant at time of printing

Eligibility and Support: Ann Simmons

TMHP and DSHS Contact Information

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1.2.2.3 Region 3

Wichita Falls OfficePO Box 300 (mailing address) 6515 Kemp Boulevard (physical address) Wichita Falls, TX 76307

Telephone: 1-940-689-5930Fax: 1-940-689-5925

Medical Case Manager: Judy Keddy, LBSW

Eligibility and Support: Anita Lancaster, LBSW

Regional Office (Arlington)Department of State Health Services Health Service Regions 2 and 3 1301 South Bowen Road, Suite 200 Arlington, TX 76013

Telephone: 1-817-264-4627, 1-817-264-4624or 1-817-264-4539

Fax: 1-817-264-4911

Director of Social Work Services:Crystal Womack, LMSW-AP

Case Management Consultants:Bea Hilton, LMSW-AP

Carol Sorich, LCSW

Medical Case Managers:Courtney Bindel, LBSW

Glenda Foreman, LCSW

Larry Goodman, LMSW

Tongua Mayfield, LBSW

Cynthia Morrison, LBSW

Kaye Morrison, LMSW

Tom Sanders, LBSW

Eligibility and Support:Debbie Davidson

Mary Hamilton

PJ Hunt

Ana Kumpf

Denton Office3612 East McKinney Denton, TX 76209

Telephone: 1-888-456-2770, Ext. 287Fax: 1-940-591-6254

Medical Case Managers:Karen Long-DeSmit, LCSW

Peggy White, LMSW

Granbury Office1322 Paluxy Road, Suite 1 Granbury, TX 76048

Telephone: 1-817-579-0313Fax: 1-817-279-0841

Medical Case Manager:Barbara Dubey, LBSW

Rockwall Office102 South First Street, Suite A Rockwall, TX 75087

Telephone: 1-972-722-6976Fax: 1-972-771-3080

Medical Case Manager:Jan Bellman, LCSW

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1.2.2.4 Region 4

Regional Office (Tyler)Department of State Health Services Health Service Region 4 and 5-North 1517 West Front Street Tyler, TX 75702

Telephone: 1-903-533-5231Fax: 1-903-595-4706

Director of Social Work Services:Peggy Wooten, ACSW, LCSW

Associate Director of Social Work Services:David Leary, LMSW

Assistant Director of Social Work Services:Lori Kelley, LBSW, MSSW

Medical Case Managers:Jo Ann Cliver, LBSW

Milinda Mezayek, LBSW

Provider Relations:Caleb Rackley, LBSW, MSSW

Eligibility and Support:Anna James

Cynthia Jones

Shirley Mayfield

Beth Wilson

Athens Office708 East Corsicana Athens, TX 75751

Telephone: 1-903-675-9107Fax: 1-903-675-3622

Medical Case Manager:Marla Phillips, LBSW

Carthage Office1412 South Adams Carthage, TX 75633

Telephone: 1-903-693-9322 or 1-800-306-0568Fax: 1-903-694-2316

Medical Case Manager:Sherry Lynn Adams, LBSW

Daingerfield Office205 Jefferson Daingerfield, TX 75638

Telephone: 1-903-645-3211Fax: 1-903-645-2864

Assistant Director of Social Work Services/Medical Case Manager:

Lori Kelley, LBSW, MSSW

Gilmer Office324 Yapaco Gilmer, TX 75644

Telephone: 1-903-843-3039Fax: 1-903-843-5200

Medical Case Manager:Ginger Jones, LBSW

Henderson Office1229 Lone Star Henderson, TX 75652

Telephone: 1-903-657-7579 or 1-800-306-0568Fax: 1-903-655-0104

Medical Case Manager:Sherry Lynn Adams, LBSW

TMHP and DSHS Contact Information

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Linden Office123 Kaufman PO Box 300 Linden, TX 75563

Telephone: 1-903-756-7231 or 1-866-268-6465Fax: 1-903-756-5146

Medical Case Manager:Samantha Batchelor, LBSW

Longview Office1750 North Eastman Road Longview, TX 75601

Telephone: 1-903-232-3221 or 1-866-327-1364Fax: 1-903-232-3278

Medical Case Managers:Ginger Jones, LBSW

Geraci Mack, LBSW

Mt. Pleasant Office1014 North Jefferson Mt. Pleasant, TX 75455

Telephone: 1-903-577-1929 or 1-866-268-6465Fax: 1-903-577-8957

Medical Case Manager:Samantha Batchelor, LBSW

Palestine Office100 West Brazos Palestine, TX 75801

Telephone: 1-903-729-6164Fax: 1-903-729-7034

Medical Case Manager:Marla Phillips, LBSW

Paris Office1460 19th Street NW Paris, TX 75460

Telephone: 1-903-737-0236Fax: 1-903-737-0220

Medical Case Manager:Misty D. Ray, LMSW

Quitman OfficePO Box 1704 (Mailing) 213 West Bermuda (Physical location) Quitman, TX 75783

Telephone: 1-903-763-1238Fax: 1-903-763-5449

Medical Case Manager:Michelle Evans, LBSW

Sulphur Springs Office1400 College, Suite 167 Sulphur Springs, TX 75482

Telephone: 1-903-439-9331Fax: 1-903-885-1166

Medical Case Manager:Michelle Evans, LBSW

Texarkana Office410-B Baylor Texarkana, TX 75501

Telephone: 1-903-838-2629Fax: 1-903-838-2596

Medical Case Manager:Tangela Oliver, LBSW

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1.2.2.5 Region 5 North

Center Office420 Tenaha Street Center, TX 75935

Telephone: 1-936-591-0525, Ext. 242Fax: 1-936-591-0162

Medical Case Manager/Provider Relations:Sandra Garrett, LBSW

Crockett OfficeSouthgate Shopping Center 1034 South Fourth Street Crockett, TX 75835

Telephone: 1-936-544-4734Fax: 1-936-544-0280

Medical Case Manager:Mable Thompson, LBSW

Jasper OfficeJasper Newton County Public Health District 139 West Lamar Jasper, TX 75951

Telephone: 1-409-384-6829, Ext. 231Fax: 1-409-384-7861

or

Burke Center RR 2, Box 317 (FM 777) Jasper, TX 75951

Telephone: 1-409 489-0506Fax: 1-409 384-6969

Medical Case Manager:Fleta Youngblood, LBSW (CSHCN Contract)

Medical Case Manager:Phyllis McGuire-Dearmon, LMSW

Livingston Office410 East Church, Suite B Livingston, TX 77351

Telephone: 1-936-328-8243 or 1-936-328-8245Fax: 1-936-328-8249

Assistant Director of Social Work Services:Jana Estrada, LMSW

Medical Case Manager:Mona West, LBSW

Lufkin OfficeAngelina County and City Health District 503 Hill Street Lufkin, TX 75904

Telephone: 1-936-632-1250Fax: 1-936-633-0613

Medical Case Manager:Amanda Spencer, LBSW, MSW (CSHCN Contract)

Nacogdoches 2027 North Stallings Drive, Suite B Nacogdoches, TX 75964

Telephone: 1-936-569-5421Fax: 1-936-569-5454

Medical Case Manager:Regina Crain, LBSW

Woodville Office201 Willow Street Woodville, TX 75979

Telephone: 1-409-283-2907Fax: 1-409-283-6071

Medical Case Manager:Mona West, LBSW

TMHP and DSHS Contact Information

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1.2.2.6 Regions 5 South and 6

1.2.2.7 Region 7

Regional Office (Houston)Department of State Health Services/ Public Health Health Service Regions 5 and 6 South 5425 Polk Avenue, Suite J Social Work/CSHCN/MDCP Department Houston, TX 77023-1497

Telephone: 1-713-767-3111Fax: 1-713-767-3125

Director of Social Work Services:Raymond Turner, MA, LMSW-AP

Medical Case Managers:Katherine Spencer, MA, LCSW

Thomas Flores, LMSW

Pamela Golden, LBSW

Calantha Griffin, BSN, MPH, RN

Monita Maxwell, LMSW

Chalandra Robinson, LMSW

Shannon Thurmond, LCSW

Cheronda Wafer, LBSW

Patricia Williams, LBSW

Eligibility and Support:Nancy Benedick

Teresa Figures

Beatriz Garcia

Sandra Kennerson

Janice Sims

Coralyn Taylor

Sickle Cell Coordinator:Linda McDuffie

Beaumont Office785 Liberty Street Beaumont, TX 77701

Telephone: 1-409-951-3091Fax: 1-409-951-3029

Medical Case Managers:Karen Ziegler, BA

Judy Melling, BS, LBSW

Conroe Office608 North Loop East Conroe, TX 77301

Telephone: 1-936-760-4704Fax: 1-936-760-4840

Medical Case Manager:Cathie Richardson, MSW, LCSW

Regional Office (Temple)Department of State Health Services Health Service Region 7 2408 South 37th Street Temple, TX 76504

Telephone: 1-254-778-6744Fax: 1-254-778-4066

Director of Social Work Services:Eileen Walker, MS, LBSW

Medical Case Manager:Lillian Lessenger, LBSW

Eligibility and Support: Alice Watkins

Judith Jackson

Vacant at time of printing

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1.2.2.8 Region 8

Austin Office1601 Rutherford Lane, Building C, Suite C-3 Austin, TX 78754

Telephone: 1-512-873-6300Fax: 1-512-873-6334 or 1-512-873-6345

Case Management Team Leaders:Vacant at time of printing

Suzan Cooper, LBSW

Medical Case Managers:Elaine Mittel, LBSW

David Ross, LCSW

Eligibility and Support: Wanda Bernhardt

Maggie Chavez

Veronica Sanchez

Navasota OfficePO Box 1287 Navasota, TX 77868

Telephone: 1-936-825-7586Fax: 1-936-825-0380

Medical Case Manager:Bettye Bullock, LBSW

Waco Office801 Austin Avenue No. 4 Waco, TX 76703 Telephone: 1-254-757-0679

Fax: 1-254-753-0879

Medical Case Managers:Dixie Skeen, LBSW

Jan Lamar, LBSW

Regional Office (San Antonio)Department of State Health Services Health Service Region 8 7430 Louis Pasteur Drive San Antonio, TX 78229

Telephone: 1-210-949-2155Fax: 1-210-949-2047

Director of Social Work Services:Vicky Contreras, LCSW

Team Leader of Social Work Services:John Garcia, LMSW

Sal Hernandez, MPH

Medical Case Managers:Sonia Gomez, LBSW

Julie Morquecho, BA

Dana Sorick, LBSW

Malachi Troup, MSW

Eligibility and Support: Rosemary Amendariz

Rebecca De La Rosa

Rosa Romero

Lupe Saldana

Del Rio Office1401 Las Vacas Del Rio, TX 78840

Telephone: 1-830-768-2800Fax: 1-830-774-6380

Medical Case Manager:Sharlene Perez, LBSW, MEd

TMHP and DSHS Contact Information

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1.2.2.9 Regions 9 and 10

Eagle Pass Office1593 Veterans Boulevard Eagle Pass, TX 78852

Telephone: 1-830-773-2716, Ext. 13Fax: 1-830-773-4688

Medical Case Manager:Linda Ruiz, LBSW

Uvalde Office1021 Garner Field Road Uvalde, TX 78801

Telephone: 1-830-278-7173Fax: 1-830-278-7170

Medical Case Manager:Rosie DeAnda, LBSW

Victoria Office1502 East Airline, No. 39 Victoria, TX 77901

Telephone: 1-361-574-7421Fax: 1-361-574-7396

Medical Case Manager:Kay Roeh, LMSW-AP

Regional Office (El Paso)Department of State Health Services Health Service Region 9 and 10 401 East Franklin, Suite 210 El Paso, TX 79901-1206

Telephone: 1-915-834-7675Fax: 1-915-834-7804

Medical Case Managers:Pedro (Pete) Adame, LBSW

Frank Encinas, LBSW

Agustin (Gus) Lopez, LBSW

Armando Rodriguez, LBSW

Martha Payan-Salgado, LBSW

Brenda Rubio-Soto, LBSW

Eligibility and Support:Beatriz (Betty) Hernandez

Beatriz (Bea) Leyva

Mary Ann Villalobos

Midland Office2301 N Big Spring Street, Suite 300 Midland, TX 79705

Telephone: 1-432-683-9492Fax: 1-432-684-3932

Director of Social Work Services: Joanne Mundy, LBSW

Medical Case Manager: Beatrix Ho Guin, LBSW

Support Staff:Gracie Terrazas

San Angelo Office622 South Oakes, Suite H San Angelo, TX 76903

Telephone: 1-325-659-7850Fax: 1-325-655-6798

Medical Case Manager:Vacant at time of printing

Support Staff:Della Carter

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1.2.2.10 Region 11

Regional Office (Harlingen)Department of State Health Services Health Service Region 11 601 West Sesame Dr Harlingen, TX 78550

Telephone: 1-956-423-0130Fax: 1-956-444-3294

Director of Social Work Services:R. Scott Hornéy, LCSW

Case Management Consultant (Valley):Rosalie Cavazos, LBSW

Medical Case Managers:Vacant at time of printing

Michael Garcia, LBSW

Gregoria Lopez, LBSW

Eligibility and Support:Norma Villanueva

Elizabeth D. Rodriguez

Alice Offices204 East First Alice, TX 78332

Telephone: 1-361-668-0747Fax: 1-361-668-8919

or

408 N. Flournoy, Suite C Alice, TX 78332

Telephone: 1-361-668-1954Fax: 1-361-668-3202

Medical Case Manager:Hector E Gonzalez, LBSW

Medical Case Manager:Juan A. Sanchez, LBSW

Beeville Office1701 NW Frontage Road Beeville, TX 78102

Telephone: 1-361-358-2241Fax: 1-361-358-0572

Medical Case Manager:Margarita Rodriguez, LBSW, MA

Corpus Christi Office1233 Agnes Street Corpus Christi, TX 78401

Telephone: 1-361-889-3484Fax: 1-361-883-4414

Case Management Consultant (Coastal Bend):

Imelda Salinas-Garcia, LMSW-AP

Medical Case Manager:Woodrow Mac Sanders, LBSW

Eligibility and Support:Rosie Tagle

Becky Thomas

Laredo Office1500 Arkansas Avenue, Suite 3 Laredo, TX 78043

Telephone: 1-956-723-6889Fax: 1-956-712-8019

Medical Case Managers:Ramiro Luna, LBSW

Vacant at time of printing

Eligibility and Support:Connie Garcia

TMHP and DSHS Contact Information

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McAllen Office901 East Vermont, No. C McAllen, TX 78503

Telephone: 1-956-618-5433 or 1-956-618-3253Fax: 1-956-630-4904

Case Management Consultant (Valley):Rosalie Cavazos, LBSW

Medical Case Managers:Edward Pumarejo, LBSW

Martha C. Partida, LBSW

Alberto Ramos, Jr., LBSW

Eligibility and Support: Yolanda Segovia

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1.3 DSHS Map