Provider Demographics
NPI:1528602828
Name:CONRAD, DAMARIS ELLEN (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:ELLEN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:DAMARIS
Other - Middle Name:ELLEN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD LMFT
Mailing Address - Street 1:205 S LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8077
Mailing Address - Country:US
Mailing Address - Phone:208-463-6366
Mailing Address - Fax:
Practice Address - Street 1:205 S LANCASTER DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-8077
Practice Address - Country:US
Practice Address - Phone:208-463-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFT6947106H00000X
CAMFT33016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist