Active NPI
Connie Park, PH.D.
- Professional Counselor
- Round Rock, TX
National Provider Identifier
1740376284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 272
- Practice address
- 410 W. Liberty Ave.
Round Rock, TX 78664 - Phone
- (512) 223-4829
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 272 | TX | Primary |
Addresses
Primary practice location
410 W. Liberty Ave.
Round Rock, TX 78664
Mailing address
411 Palos Verdes Dr.
Austin, TX 78734
Phone (512) 659-9928
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 272 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740376284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 PALOS VERDES DR.",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78734",
"telephone_number": "512-659-9928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 W. LIBERTY AVE.",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "78664",
"telephone_number": "512-223-4829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CONNIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.