Provider Demographics
NPI:1306998059
Name:PRICE, CONNIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 BELLAIRE BLVD
Mailing Address - Street 2:STE 145
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4505
Mailing Address - Country:US
Mailing Address - Phone:713-839-9090
Mailing Address - Fax:713-839-9092
Practice Address - Street 1:4710 BELLAIRE BLVD
Practice Address - Street 2:STE 145
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4505
Practice Address - Country:US
Practice Address - Phone:713-839-9090
Practice Address - Fax:713-839-9092
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16282104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100599302Medicaid