Provider Demographics
NPI:1841402872
Name:CONNER, MICHAEL GRAYSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GRAYSON
Last Name:CONNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 NE WIEST WAY
Mailing Address - Street 2:NO. 2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4285
Mailing Address - Country:US
Mailing Address - Phone:541-388-5660
Mailing Address - Fax:
Practice Address - Street 1:965 NE WIEST WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4285
Practice Address - Country:US
Practice Address - Phone:541-617-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical