Provider Demographics
NPI:1093267551
Name:CONNER, BRIAN (LMFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CONNER
Suffix:
Gender:M
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9312
Mailing Address - Country:US
Mailing Address - Phone:979-533-4279
Mailing Address - Fax:
Practice Address - Street 1:206 W MONSERATTE ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-4330
Practice Address - Country:US
Practice Address - Phone:979-533-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist