Provider Demographics
NPI:1013101039
Name:VENHAUS, CONNIE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:KAY
Last Name:VENHAUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9157
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71910-9157
Mailing Address - Country:US
Mailing Address - Phone:501-915-4080
Mailing Address - Fax:
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-701-6213
Practice Address - Fax:501-622-6623
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10-19P103TC0700X
AR09-01AU-PL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical