Provider Demographics
NPI:1457340044
Name:CONLEY, MICHAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 N 28TH DR STE 265
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4377
Mailing Address - Country:US
Mailing Address - Phone:602-866-0230
Mailing Address - Fax:
Practice Address - Street 1:11024 N 28TH DR
Practice Address - Street 2:STE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4377
Practice Address - Country:US
Practice Address - Phone:602-866-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0502101YP2500X
AZLPC0502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional