Provider Demographics
NPI:1083765119
Name:CONRAD, BREE R (MA)
Entity Type:Individual
Prefix:MS
First Name:BREE
Middle Name:R
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 N WINNEBAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WINNEBAGO
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9400
Mailing Address - Country:US
Mailing Address - Phone:816-286-5098
Mailing Address - Fax:
Practice Address - Street 1:400 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3703
Practice Address - Country:US
Practice Address - Phone:816-452-8910
Practice Address - Fax:816-452-0245
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABREEPRYORMedicare ID - Type UnspecifiedSUBSTANCE USE ORDER