Provider Demographics
NPI:1538280805
Name:CONRAD, ROY CARL (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:CARL
Last Name:CONRAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 S BITTERROOT PL STE 303
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-1610
Mailing Address - Country:US
Mailing Address - Phone:605-361-8876
Mailing Address - Fax:
Practice Address - Street 1:7401 S BITTERROOT PL STE 303
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-1610
Practice Address - Country:US
Practice Address - Phone:605-361-8876
Practice Address - Fax:605-271-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2065101YM0800X
SDLPCMH2065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD990241012878OtherPREFERRED ONE
SD22327OtherSIOUX VALLEY HEALTH PLAN
SD6576550Medicaid