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General NPI Number Information
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NPI Number | 1649473133
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Entity Type | Individual
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Provider Name | MARYDORA CONLEY LMFT, LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 516 ACADEMY RIDGE PL
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City | LOUISVILLE
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State | KY
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Zip | 40245-3934
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Country | US
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Telephone | 502-500-1553
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Fax |
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Provider Business Mailing Address
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Address Line | 516 ACADEMY RIDGE PL
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City | LOUISVILLE
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State | KY
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Zip | 40245-3934
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Country | US
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Telephone | 502-500-1553
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1966
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 105233
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1966
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License Number State | KY
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