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NPI Code Detail

MEDICARE: DR. LAVONNA CONNELL PSYD

MEDICARE: DR. LAVONNA CONNELL PSYD
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
1103TC0700XClinical Psychologist37752TX

General Provider Information

NPI Number : 1356741490
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAVONNA CONNELL PSYD
Provider Business Mailing Address
First Line : PSC 475 BOX 1
Second Line :
City : FPO
State : AP
Zip : 96350-1200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : PSC 475 BOX 1
Second Line :
City : FPO
State : AP
Zip : 96350-1200
Country : US
Telephone Number : --
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2014
Last Update Date : 04/19/2026

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