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General NPI Number Information
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NPI Number | 1346824505
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Entity Type | Individual
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Provider Name | BENJAMIN GRADY CONDRAY LPC
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Gender | Male
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 1850 S MIDLOTHIAN PKWY
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7581
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Country | US
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Telephone | 972-824-3065
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 S MIDLOTHIAN PKWY
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7581
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Country | US
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Telephone | 972-775-9050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 16614
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License Number State | TX
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