Provider Demographics
NPI:1508298647
Name:MARNELL, MEGHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:MARNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 BUSINESS INTERSTATE 40
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2329
Mailing Address - Country:US
Mailing Address - Phone:806-607-5930
Mailing Address - Fax:806-482-1609
Practice Address - Street 1:9525 BUSINESS INTERSTATE 40
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2329
Practice Address - Country:US
Practice Address - Phone:806-607-5930
Practice Address - Fax:806-482-1609
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36430103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200765110AMedicaid
NM27755533Medicaid
TX327450803Medicaid
TX3274508-01Medicaid
TX327450802Medicaid