Healthcare Provider Details

I. General information

NPI: 1164287181
Provider Name (Legal Business Name): FRANK EDWARD CONAWAY JR. CATC II 2214150 II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E HILLCREST DR STE 110
THOUSAND OAKS CA
91360-4226
US

IV. Provider business mailing address

PO BOX 7741
WESTLAKE VILLAGE CA
91359-7741
US

V. Phone/Fax

Practice location:
  • Phone: 818-390-9444
  • Fax:
Mailing address:
  • Phone: 818-390-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: