Provider Demographics
NPI:1194211276
Name:CONRAD, JESSICA (LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 BRENTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9374
Mailing Address - Country:US
Mailing Address - Phone:419-410-5803
Mailing Address - Fax:
Practice Address - Street 1:6654 BRENTRIDGE LN
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9374
Practice Address - Country:US
Practice Address - Phone:419-410-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OHE.2303275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health