Provider Demographics
NPI:1730746785
Name:CONRAD, TYLER EUGENE (LLPC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:EUGENE
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RIPPON AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1505
Mailing Address - Country:US
Mailing Address - Phone:517-825-9807
Mailing Address - Fax:
Practice Address - Street 1:44 S BROAD ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1847
Practice Address - Country:US
Practice Address - Phone:517-825-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty