Provider Demographics
NPI:1700378544
Name:CONNECTIONS OF HOPE
Entity Type:Organization
Organization Name:CONNECTIONS OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNEFAX
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LSSP, LPC
Authorized Official - Phone:903-330-5579
Mailing Address - Street 1:121 S BROADWAY AVE STE 528
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7209
Mailing Address - Country:US
Mailing Address - Phone:903-330-5579
Mailing Address - Fax:903-865-5100
Practice Address - Street 1:121 S BROADWAY AVE STE 528
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7209
Practice Address - Country:US
Practice Address - Phone:903-330-5579
Practice Address - Fax:903-865-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72989261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619411204Medicaid