Provider Demographics
NPI:1609627504
Name:CONGER, KIANTE VAUGHN (LMSW)
Entity Type:Individual
Prefix:
First Name:KIANTE
Middle Name:VAUGHN
Last Name:CONGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIANTE
Other - Middle Name:VAUGHN
Other - Last Name:LEMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6300 JOHN RYAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4122
Mailing Address - Country:US
Mailing Address - Phone:817-922-6000
Mailing Address - Fax:
Practice Address - Street 1:6300 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4122
Practice Address - Country:US
Practice Address - Phone:817-922-6000
Practice Address - Fax:817-922-5955
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker