MEDICARE: NIK CONROY MA, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH61439364	WA

General Provider Information

NPI Number	:	1164901716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIK CONROY MA, LMHC

Provider Business Mailing Address
First Line	:	1420 S MERIDIAN STE B
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-6914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 S MERIDIAN STE C
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-6914
Country	:	US
Telephone Number	:	253-363-0714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	07/12/2023

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