Provider Demographics
NPI:1063516524
Name:KITCHEN, CONNIE BRANNON (LPC)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:BRANNON
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:BRANNON
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:230 PINE CIR
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-4555
Mailing Address - Country:US
Mailing Address - Phone:903-235-4779
Mailing Address - Fax:903-753-0197
Practice Address - Street 1:409 N FREDONIA ST STE 105
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6466
Practice Address - Country:US
Practice Address - Phone:903-235-4779
Practice Address - Fax:903-753-0197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4147LCOtherBCBS
TX6307LCOtherBCBS