Provider Demographics
NPI:1568193696
Name:CONNERY, CHRISTOPHER LANE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LANE
Last Name:CONNERY
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 1:668 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6470
Mailing Address - Country:US
Mailing Address - Phone:970-773-3015
Mailing Address - Fax:
Practice Address - Street 1:101 S 3RD ST STE 261
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2409
Practice Address - Country:US
Practice Address - Phone:970-639-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor