Provider Demographics
NPI:1053372979
Name:CONRAD, PHILIP (LCSW)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 SAINTSBURY DR
Mailing Address - Street 2:NO 25
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5388
Mailing Address - Country:US
Mailing Address - Phone:469-358-1060
Mailing Address - Fax:
Practice Address - Street 1:6115 SAINTSBURY DRIVE
Practice Address - Street 2:NO 25
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-5212
Practice Address - Country:US
Practice Address - Phone:469-358-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical