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General NPI Number Information
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NPI Number | 1972510782
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Entity Type | Individual
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Provider Name | CONNIE RAY EARY PH.D, LPC-S
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 02/14/2016
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Provider Practice Location Address
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Address Line | 2805 BIRDCREEK DR
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City | TEMPLE
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State | TX
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Zip | 76502-1101
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Country | US
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Telephone | 254-760-2664
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Fax |
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Provider Business Mailing Address
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Address Line | 2805 BIRDCREEK DR
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City | TEMPLE
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State | TX
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Zip | 76502-1101
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Country | US
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Telephone | 254-760-2664
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6434
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License Number State | TX
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