Provider Demographics
NPI:1003296211
Name:CROSSLEY, CONNIE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELIZABETH
Last Name:CROSSLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 SHANNONDALE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3649
Mailing Address - Country:US
Mailing Address - Phone:423-312-6365
Mailing Address - Fax:
Practice Address - Street 1:10426 JACKSON OAKS WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0711
Practice Address - Country:US
Practice Address - Phone:423-312-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist