Provider Demographics
NPI:1376542746
Name:OBRIEN-CONLEY, TERESA (LCSW CADC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:OBRIEN-CONLEY
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:
Practice Address - Street 1:7629 KY ROUTE 979
Practice Address - Street 2:
Practice Address - City:GRETHEL
Practice Address - State:KY
Practice Address - Zip Code:41631-6304
Practice Address - Country:US
Practice Address - Phone:606-587-2200
Practice Address - Fax:606-587-2203
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0521101YA0400X
KY17631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82000795Medicaid
KY82000795Medicaid