Provider Demographics
NPI:1124783923
Name:CONLEY, ELIZABETH KAY (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KAY
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1616 PARK PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1377
Mailing Address - Country:US
Mailing Address - Phone:817-921-2401
Mailing Address - Fax:817-921-2405
Practice Address - Street 1:1616 PARK PLACE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1377
Practice Address - Country:US
Practice Address - Phone:817-921-2401
Practice Address - Fax:817-921-2405
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional