Provider Demographics
NPI:1710367610
Name:CONDER, PETER BRYAN (LCMHC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRYAN
Last Name:CONDER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 S STATE ST APT 272
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1405
Mailing Address - Country:US
Mailing Address - Phone:435-720-8338
Mailing Address - Fax:
Practice Address - Street 1:2265 S STATE ST APT 272
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-1405
Practice Address - Country:US
Practice Address - Phone:435-720-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health