Provider Demographics
NPI:1063923027
Name:CONNER, CHRISTINE
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:
Last Name:CONNER
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 1:18501 GREENBRIAR AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3203
Mailing Address - Country:US
Mailing Address - Phone:504-914-4400
Mailing Address - Fax:
Practice Address - Street 1:1707 GARDERE LN STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-8144
Practice Address - Country:US
Practice Address - Phone:225-831-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health