Provider Demographics
NPI:1174799381
Name:CONKRITE, PRISCILLA JEAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:JEAN
Last Name:CONKRITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4744
Mailing Address - Country:US
Mailing Address - Phone:909-967-7391
Mailing Address - Fax:
Practice Address - Street 1:1660 W MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1200
Practice Address - Country:US
Practice Address - Phone:213-924-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty