Provider Demographics
NPI:1457827370
Name:MAHR, CONRAD PETER (MA, TLLP)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:PETER
Last Name:MAHR
Suffix:
Gender:M
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1227
Mailing Address - Country:US
Mailing Address - Phone:248-345-3889
Mailing Address - Fax:
Practice Address - Street 1:23 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2332
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:734-621-5075
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017647103T00000X
MI6361007659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist