Healthcare Provider Details

I. General information

NPI: 1467382010
Provider Name (Legal Business Name): CONRAD CANNELL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 N MAIN ST
LOGAN UT
84321-3915
US

IV. Provider business mailing address

486 E 750 N
SMITHFIELD UT
84335-5512
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-9278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11303181-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: