Provider Demographics
NPI:1588857213
Name:CONNER, KRISTEN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:CONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4500 EMERALD LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6772
Mailing Address - Country:US
Mailing Address - Phone:817-996-0491
Mailing Address - Fax:817-335-7927
Practice Address - Street 1:1220 W PRESIDIO ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4512
Practice Address - Country:US
Practice Address - Phone:817-335-6429
Practice Address - Fax:817-335-7927
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical