Provider Demographics
NPI:1639535149
Name:SHANKLE, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SHANKLE
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 1:183 HIVER CIR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5501
Mailing Address - Country:US
Mailing Address - Phone:737-303-6780
Mailing Address - Fax:
Practice Address - Street 1:10816 CROWN COLONY DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1639
Practice Address - Country:US
Practice Address - Phone:541-519-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX646871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical