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General NPI Number Information
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NPI Number | 1497985436
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Entity Type | Organization
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Legal Business Name | CONFERO PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 1105 WOODED ACRES DR SUITE #270
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City | WACO
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State | TX
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Zip | 76710-4468
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Country | US
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Telephone | 254-751-1164
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Fax | 254-751-1736
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Provider Business Mailing Address
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Address Line | 1105 WOODED ACRES DR SUITE #270
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City | WACO
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State | TX
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Zip | 76710-4468
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Country | US
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Telephone | 254-751-1164
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Fax | 254-751-1736
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Authorized Official
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Title or Position | OWNER
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Name | KIM UPRIGHT
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Credential | LPC
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Telephone | 254-751-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63675
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License Number State | TX
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