Provider Demographics
NPI:1548573256
Name:DR. NYDIA CONRAD COUNSELING & PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Entity Type:Organization
Organization Name:DR. NYDIA CONRAD COUNSELING & PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-480-6427
Mailing Address - Street 1:3848 FLATIRON LOOP UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7825
Mailing Address - Country:US
Mailing Address - Phone:813-480-6427
Mailing Address - Fax:813-788-3492
Practice Address - Street 1:3848 FLATIRON LOOP UNIT 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7825
Practice Address - Country:US
Practice Address - Phone:813-480-6427
Practice Address - Fax:813-788-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8091261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)