Provider Demographics
NPI:1700408036
Name:SCHNELL, RANDY E
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:E
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4433
Mailing Address - Country:US
Mailing Address - Phone:901-870-6097
Mailing Address - Fax:888-519-3386
Practice Address - Street 1:4646 POPLAR AVE STE 320
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4433
Practice Address - Country:US
Practice Address - Phone:901-870-6097
Practice Address - Fax:888-519-3386
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1289103TC2200X
103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool