Healthcare Provider Details

I. General information

NPI: 1891516274
Provider Name (Legal Business Name): PARIS CONWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4799 RIVER RD
BUHL ID
83316-5104
US

IV. Provider business mailing address

5250 IROQUOIS CT
CLARKSTON MI
48348-3012
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-0407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7761873
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: