Provider Demographics
NPI:1760266589
Name:CONRAD, SIMON (LMHCA)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 JEFFERSON ST SE # 902
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1441
Mailing Address - Country:US
Mailing Address - Phone:360-485-6661
Mailing Address - Fax:
Practice Address - Street 1:900 JEFFERSON ST SE # 902
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1441
Practice Address - Country:US
Practice Address - Phone:360-485-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health