Provider Demographics
NPI:1063553782
Name:CONELY, CRYSTAL
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:CONELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 LONG BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-7212
Mailing Address - Country:US
Mailing Address - Phone:901-785-7671
Mailing Address - Fax:
Practice Address - Street 1:5515 SHELBY OAKS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7316
Practice Address - Country:US
Practice Address - Phone:901-252-7600
Practice Address - Fax:901-252-7620
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health