Provider Demographics
NPI:1174628465
Name:CONDRA, CHRIS ALLEN (MS)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:ALLEN
Last Name:CONDRA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 NW PARKER CT
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-1581
Mailing Address - Country:US
Mailing Address - Phone:816-228-4943
Mailing Address - Fax:816-228-4943
Practice Address - Street 1:4224 S HOCKER DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4754
Practice Address - Country:US
Practice Address - Phone:816-795-0004
Practice Address - Fax:816-228-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000308101YP2500X
MO01317103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling