Healthcare Provider Details

I. General information

NPI: 1508261181
Provider Name (Legal Business Name): CHAD R CONARD LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2014
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BELMONT AVE
YOUNGSTOWN OH
44502-1039
US

IV. Provider business mailing address

365 RIFFEL RD SUITE B
WOOSTER OH
44691-8592
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-2487
  • Fax: 330-743-5748
Mailing address:
  • Phone: 330-345-3461
  • Fax: 330-345-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1300461
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1300461
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1300461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: