Provider Demographics
NPI:1528069929
Name:VENABLE, WILLIAM MARK (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:VENABLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TEAGUE DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2640
Mailing Address - Country:US
Mailing Address - Phone:903-892-4466
Mailing Address - Fax:903-892-2634
Practice Address - Street 1:1800 TEAGUE DR
Practice Address - Street 2:SUITE 502
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2656
Practice Address - Country:US
Practice Address - Phone:903-892-4466
Practice Address - Fax:903-892-2634
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14504103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0403776-01Medicaid
TX82413PMedicare ID - Type UnspecifiedMEDICARE IDENTIFIER
TX0403776-01Medicaid