Provider Demographics
NPI:1457080467
Name:ISOM, CONLELA (LMSW)
Entity Type:Individual
Prefix:
First Name:CONLELA
Middle Name:
Last Name:ISOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 FAWN LILY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7801
Mailing Address - Country:US
Mailing Address - Phone:254-768-4057
Mailing Address - Fax:
Practice Address - Street 1:1127 FAWN LILY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7801
Practice Address - Country:US
Practice Address - Phone:254-768-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107590104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker