Provider Demographics
NPI:1700565645
Name:CONLEY, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4882 RONEY RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9381
Mailing Address - Country:US
Mailing Address - Phone:360-399-4920
Mailing Address - Fax:
Practice Address - Street 1:4882 RONEY RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-9381
Practice Address - Country:US
Practice Address - Phone:360-399-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61574132101YM0800X
WACG61467722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor