Provider Demographics
NPI:1972510782
Name:EARY, CONNIE RAY (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:RAY
Last Name:EARY
Suffix:
Gender:M
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 BIRDCREEK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1101
Mailing Address - Country:US
Mailing Address - Phone:254-760-2664
Mailing Address - Fax:
Practice Address - Street 1:2805 BIRDCREEK DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1101
Practice Address - Country:US
Practice Address - Phone:254-760-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172647301Medicaid