Provider Demographics
NPI:1568503506
Name:CONNIE, ELLIOTT EUGENE (LPC-I)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:EUGENE
Last Name:CONNIE
Suffix:
Gender:M
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 TRANQUILITY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2057
Mailing Address - Country:US
Mailing Address - Phone:817-457-3221
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:SUITE 509
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4909
Practice Address - Country:US
Practice Address - Phone:817-870-1080
Practice Address - Fax:817-870-1085
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62681101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health