Provider Demographics
NPI:1275051476
Name:CONNER, ADRIAN (MA)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:CONNER
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 1:638 AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0217
Mailing Address - Country:US
Mailing Address - Phone:530-440-1538
Mailing Address - Fax:
Practice Address - Street 1:638 AZALEA AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0217
Practice Address - Country:US
Practice Address - Phone:530-440-1538
Practice Address - Fax:530-605-0645
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI4277101YP2500X
CAIMFT101501106H00000X
CA124030106H00000X
CAMFT124030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist