Healthcare Provider Details

I. General information

NPI: 1700408036
Provider Name (Legal Business Name): RANDY E SCHNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 POPLAR AVE STE 320
MEMPHIS TN
38117-4433
US

IV. Provider business mailing address

4646 POPLAR AVE STE 320
MEMPHIS TN
38117-4433
US

V. Phone/Fax

Practice location:
  • Phone: 901-870-6097
  • Fax: 888-519-3386
Mailing address:
  • Phone: 901-870-6097
  • Fax: 888-519-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP1289
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: