Provider Demographics
NPI:1639669559
Name:CRESS, CONNER
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:CRESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N 78TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4731
Mailing Address - Country:US
Mailing Address - Phone:678-763-8146
Mailing Address - Fax:
Practice Address - Street 1:5227 BALLARD AVE NW STE 9
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4847
Practice Address - Country:US
Practice Address - Phone:678-763-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health