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General NPI Number Information
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NPI Number | 1457827370
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Entity Type | Individual
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Provider Name | CONRAD PETER MAHR MA, TLLP
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Gender | Male
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 23 W 1ST ST
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City | MONROE
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State | MI
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Zip | 48161-2332
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Country | US
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Telephone | 734-639-2262
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Fax | 734-621-5075
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Provider Business Mailing Address
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Address Line | 2829 DALTON AVE
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City | ANN ARBOR
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State | MI
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Zip | 48108-1227
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Country | US
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Telephone | 248-345-3889
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301017647
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361007659
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License Number State | MI
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