Provider Demographics
NPI:1801253638
Name:WILMETH, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WILMETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 FM 1960 RD W STE F100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3730
Mailing Address - Country:US
Mailing Address - Phone:832-257-8959
Mailing Address - Fax:832-482-2362
Practice Address - Street 1:2611 FM 1960 RD W
Practice Address - Street 2:STE.# F-100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3731
Practice Address - Country:US
Practice Address - Phone:832-257-8959
Practice Address - Fax:832-482-2362
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3101101YA0400X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral