Provider Demographics
NPI:1447768932
Name:CONRAD, JEFFREY LANE (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LANE
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E ENON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1415
Mailing Address - Country:US
Mailing Address - Phone:937-767-1303
Mailing Address - Fax:937-767-1025
Practice Address - Street 1:360 E ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1415
Practice Address - Country:US
Practice Address - Phone:937-767-1303
Practice Address - Fax:937-767-1025
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500644101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional