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General NPI Number Information
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NPI Number | 1285011510
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Entity Type | Organization
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Legal Business Name | CONRAD SPECIALTY CONSULTING COMPANY
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1504 S 21ST PL
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City | RIDGEFIELD
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State | WA
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Zip | 98642-8017
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Country | US
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Telephone | 360-727-6558
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 251
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City | RIDGEFIELD
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State | WA
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Zip | 98642-0251
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Country | US
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Telephone | 360-727-6558
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN R. CONRAD
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Credential | CERTIFIED COUNSELOR
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Telephone | 360-727-6558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CL 60302224
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License Number State | WA
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