MEDICARE: MR. ROY CARL CONRAD PHD

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	LPC-MH2065	SD
2	101YM0800X	Mental Health Counselor	LPCMH2065	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990241012878	OTHER	SD	PREFERRED ONE
2	22327	OTHER	SD	SIOUX VALLEY HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538280805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY CARL CONRAD PHD

Provider Business Mailing Address
First Line	:	7401 S BITTERROOT PL STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-361-8876
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 S BITTERROOT PL STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-361-8876
Fax Number	:	605-271-0104

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	02/02/2023

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