Provider Demographics
NPI:1326180399
Name:CONROY, MARY ALICE (PHD,)
Entity Type:Individual
Prefix:DR
First Name:MARY ALICE
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 ELKINS LK
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-7319
Mailing Address - Country:US
Mailing Address - Phone:936-294-3806
Mailing Address - Fax:936-294-1685
Practice Address - Street 1:794 ELKINS LK
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-7319
Practice Address - Country:US
Practice Address - Phone:936-294-3806
Practice Address - Fax:936-294-1685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1699103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic