Provider Demographics
NPI:1912388216
Name:COE, CONNIE MISCHELL (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:MISCHELL
Last Name:COE
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 CIELO CT
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4648
Mailing Address - Country:US
Mailing Address - Phone:214-430-6462
Mailing Address - Fax:
Practice Address - Street 1:1345 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6943
Practice Address - Country:US
Practice Address - Phone:214-743-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12231101YA0400X
TX68342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)