Provider Demographics
NPI:1073806790
Name:CONYEARS, GABRIELLE (LPC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:CONYEARS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:CONYEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:6210 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4728
Mailing Address - Country:US
Mailing Address - Phone:501-265-0302
Mailing Address - Fax:501-265-0300
Practice Address - Street 1:6210 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4728
Practice Address - Country:US
Practice Address - Phone:501-265-0302
Practice Address - Fax:501-265-0300
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1804038101YM0800X
171M00000X
ARP2105006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236900526Medicaid