Provider Demographics
NPI:1639847320
Name:VARNELL, SHANA JANETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:JANETTE
Last Name:VARNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FREEDOM PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2184
Mailing Address - Country:US
Mailing Address - Phone:915-443-9669
Mailing Address - Fax:
Practice Address - Street 1:109 FREEDOM PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2184
Practice Address - Country:US
Practice Address - Phone:915-443-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38922103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling