Provider Demographics
NPI:1245575521
Name:BATISTE, SHAWNNELL
Entity Type:Individual
Prefix:
First Name:SHAWNNELL
Middle Name:
Last Name:BATISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1871
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78646-1871
Mailing Address - Country:US
Mailing Address - Phone:512-621-7599
Mailing Address - Fax:
Practice Address - Street 1:205 KING ELDER LN
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1738
Practice Address - Country:US
Practice Address - Phone:470-331-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80105101Y00000X, 101YM0800X
LA6169101Y00000X, 101YM0800X, 101YP2500X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3873614-03Medicaid
TX3873614-02Medicaid