Provider Demographics
NPI:1922212802
Name:NAGEL, CONRAD THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:THOMAS
Last Name:NAGEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10875 RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:MI
Mailing Address - Zip Code:49709
Mailing Address - Country:US
Mailing Address - Phone:989-785-5474
Mailing Address - Fax:
Practice Address - Street 1:154 S RIPLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-3406
Practice Address - Country:US
Practice Address - Phone:989-356-6385
Practice Address - Fax:989-356-4909
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801076779101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)