Provider Demographics
NPI:1952375925
Name:CONLEY, BECKY J
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:J
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BECKY
Other - Middle Name:J
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:340 NE MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4120
Mailing Address - Country:US
Mailing Address - Phone:509-334-1133
Mailing Address - Fax:509-332-1608
Practice Address - Street 1:340 NE MAPLE ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4120
Practice Address - Country:US
Practice Address - Phone:509-334-1133
Practice Address - Fax:509-332-1608
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00328642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8190969Medicaid
WA8190969Medicaid