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NPI Code Detail

MEDICARE: CHARMAINE LANAE CONNER

MEDICARE: CHARMAINE LANAE CONNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor75869TX

General Provider Information

NPI Number : 1134777279
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARMAINE LANAE CONNER
Provider Business Mailing Address
First Line : 3067 FALCON RD
Second Line :
City : PROSPER
State : TX
Zip : 75078-8825
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number : 214-659-1293
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2019
Last Update Date : 03/16/2026

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Directions to “ CHARMAINE LANAE CONNER ” Practice Location

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