MEDICARE: CONRAD COUNSELING & CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730800103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONRAD COUNSELING & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	7401 S BITTERROOT PL STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-361-8876
Fax Number	:	605-361-8876

Provider Business Practice Location Address
First Line	:	7401 S BITTERROOT PL STE 303
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1610
Country	:	US
Telephone Number	:	605-361-8876
Fax Number	:	605-361-8876

Authorized Official
Title or Position	:	PRIVATE PRACTITIONER
Name	:	DR. ROY CARL CONRAD
Credential	:	PHD
Telephone Number	:	605-361-8876

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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