Provider Demographics
NPI:1114995198
Name:CONLEY, ALTHEA T (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALTHEA
Middle Name:T
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10193
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0023
Mailing Address - Country:US
Mailing Address - Phone:870-881-9948
Mailing Address - Fax:870-881-9940
Practice Address - Street 1:404 S BRADLEY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3459
Practice Address - Country:US
Practice Address - Phone:870-367-2461
Practice Address - Fax:870-367-2363
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE40702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M977OtherBLUE CROSS
AR154660001Medicaid
AR5M977Medicare ID - Type Unspecified
ARH54832Medicare UPIN