1003971334 NPI number — MRS. JUDITH ELIZABETH CONRAD MA LPC

Table of content: MRS. JUDITH ELIZABETH CONRAD MA LPC (NPI 1003971334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003971334 NPI number — MRS. JUDITH ELIZABETH CONRAD MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONRAD
Provider First Name:
JUDITH
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003971334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 58275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-744-5000
Provider Business Mailing Address Fax Number:
304-744-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOX 405L
Provider Second Line Business Practice Location Address:
ROUTE 8
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-744-5000
Provider Business Practice Location Address Fax Number:
304-744-6677
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  887 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com