Provider Demographics
NPI:1750530879
Name:CONRAD, CLIFFORD DEAN JR (LPC)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DEAN
Last Name:CONRAD
Suffix:JR
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 1:217 ROSAMOND ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2023
Mailing Address - Country:US
Mailing Address - Phone:517-749-7870
Mailing Address - Fax:
Practice Address - Street 1:216 CASS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2507
Practice Address - Country:US
Practice Address - Phone:517-749-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional