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General NPI Number Information
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NPI Number | 1568131076
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Entity Type | Individual
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Provider Name | GARRICK DEWAYNE CONNER MA, LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 209 ROYA LANE, STE. 4
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City | BRYANT
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State | AR
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Zip | 72022-7211
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Country | US
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Telephone | 501-551-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 8001 N HILLS BLVD
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-4904
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Country | US
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Telephone | 501-551-4144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P1308092
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M1308044
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License Number State | AR
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