Organization
SHANA CONOVER, M.A., LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANA JEAN CONOVER LPC (OWNER)
(903) 534-6240
Entity
Organization
Contact information
Practice address
100 INDEPENDENCE CENTER SUITE 208, TYLER, TX 75703
(903) 534-6240
(903) 534-6248
Mailing address
100 INDEPENDENCE CENTER SUITE 208, TYLER, TX 75703
(903) 534-6240
(903) 534-6248
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
18503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023NU
BC/BS PROVIDER NUMBER
TX
01
—
11568031
CAQH PROVIDER ID
TX
01
—
1235200072
NPI NUMBER
TX
Enumeration date
06/02/2008
Last updated
06/16/2009
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