Provider Demographics
NPI:1730768698
Name:KELLY, CONNIE LM (LPC)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LM
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 WOLF BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5969
Mailing Address - Country:US
Mailing Address - Phone:713-857-9958
Mailing Address - Fax:
Practice Address - Street 1:15010 WOLF BRANCH CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5969
Practice Address - Country:US
Practice Address - Phone:832-280-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional