Provider Demographics
NPI:1821123191
Name:HAMRIC, CONRAD ALLEN (LCSW LMFT)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:ALLEN
Last Name:HAMRIC
Suffix:
Gender:M
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N WINDOMERE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-289-3164
Mailing Address - Fax:972-248-4599
Practice Address - Street 1:17440 N DALLAS PARKWAY
Practice Address - Street 2:SUITE 208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287
Practice Address - Country:US
Practice Address - Phone:214-289-3164
Practice Address - Fax:972-248-4599
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172741041C0700X
TX3230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist