Provider Demographics
NPI:1437668761
Name:CONWAY, CONTRELLA E (MHP)
Entity Type:Individual
Prefix:
First Name:CONTRELLA
Middle Name:E
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MHP
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 12234
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-2234
Mailing Address - Country:US
Mailing Address - Phone:337-255-6769
Mailing Address - Fax:
Practice Address - Street 1:7717 HOPELAND PLANTATION DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-9663
Practice Address - Country:US
Practice Address - Phone:337-255-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health