Provider Demographics
NPI:1003383670
Name:UY, DON CONRAD G
Entity type:Individual
Prefix:
First Name:DON CONRAD
Middle Name:G
Last Name:UY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29404 NE TIMMEN RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9265
Mailing Address - Country:US
Mailing Address - Phone:813-991-2873
Mailing Address - Fax:
Practice Address - Street 1:1610 C ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3440
Practice Address - Country:US
Practice Address - Phone:360-787-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60907372101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)