MEDICARE: WILLIAM MARK VENABLE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	14504	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528069929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MARK VENABLE PH.D.

Provider Business Mailing Address
First Line	:	1800 TEAGUE DR
Second Line	:	SUITE 502
City	:	SHERMAN
State	:	TX
Zip	:	75090-2640
Country	:	US
Telephone Number	:	903-892-4466
Fax Number	:	903-892-2634

Provider Business Practice Location Address
First Line	:	1800 TEAGUE DR
Second Line	:	SUITE 502
City	:	SHERMAN
State	:	TX
Zip	:	75090-2656
Country	:	US
Telephone Number	:	903-892-4466
Fax Number	:	903-892-2634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/24/2010

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