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General NPI Number Information
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NPI Number | 1912388216
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Entity Type | Individual
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Provider Name | CONNIE MISCHELL COE LPC, LCDC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 1345 RIVER BEND DR
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City | DALLAS
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State | TX
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Zip | 75247-6943
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Country | US
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Telephone | 214-743-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 2804 CIELO CT
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City | MESQUITE
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State | TX
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Zip | 75181-4648
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Country | US
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Telephone | 214-430-6462
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12231
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68342
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License Number State | TX
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