Provider Demographics
NPI:1427026640
Name:CONNELL, RICHARD
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 S W S YOUNG DR STE B-202
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2000
Mailing Address - Country:US
Mailing Address - Phone:254-628-0056
Mailing Address - Fax:254-628-2716
Practice Address - Street 1:3106 S W S YOUNG DR STE B-202
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2000
Practice Address - Country:US
Practice Address - Phone:254-628-0056
Practice Address - Fax:254-628-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029410001Medicaid