SHAUNDA RENA PETTY NPI 1447145453

NPI Information

  • NPI: 1447145453
  • Provider Name: SHAUNDA RENA PETTY
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Individual
  • Address: 719 W FRONT ST STE 262
    TYLER, TX
    ZIP 75702
  • Phone: (903) 636-3868

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NPI Details

Shaunda Rena Petty is a mental health counselor in Tyler, TX. Shaunda Rena Petty NPI is 1447145453. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

719 W FRONT ST STE 262
TYLER, TX
ZIP 75702-975
Phone: (903) 636-3868

The enumeration date for this NPI number is 6/10/2025 and was last updated on 6/10/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental Health96260TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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