Provider Demographics
NPI:1750972402
Name:CONLEY, MICHAELA ANN (MFT, NBC-HWC)
Entity type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MFT, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W SAN LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1125
Mailing Address - Country:US
Mailing Address - Phone:443-414-3532
Mailing Address - Fax:
Practice Address - Street 1:1621 W SAN LUCAS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1125
Practice Address - Country:US
Practice Address - Phone:443-414-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
793591774OtherNBC-HWC
21840OtherMCHES