Provider Demographics
NPI:1740660950
Name:MICHELLE L CONRAD LLC
Entity type:Organization
Organization Name:MICHELLE L CONRAD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-846-3726
Mailing Address - Street 1:9611 165TH ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5654
Mailing Address - Country:US
Mailing Address - Phone:708-846-3726
Mailing Address - Fax:
Practice Address - Street 1:9611 165TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5654
Practice Address - Country:US
Practice Address - Phone:708-846-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty