Provider Demographics
NPI:1336272848
Name:CONWAY, PATRICK W (QMHP)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:CONWAY
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NW LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3203
Mailing Address - Country:US
Mailing Address - Phone:541-382-8862
Mailing Address - Fax:541-382-8928
Practice Address - Street 1:39 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3203
Practice Address - Country:US
Practice Address - Phone:541-382-8862
Practice Address - Fax:541-382-8928
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR810774103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool