Provider Demographics
NPI:1215428974
Name:CLONTZ, CAROLYN JEAN (MS,LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2958
Mailing Address - Country:US
Mailing Address - Phone:817-403-8215
Mailing Address - Fax:
Practice Address - Street 1:8408 DAVIS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8610
Practice Address - Country:US
Practice Address - Phone:817-765-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15348101YA0400X
101YM0800X
TX203099106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health