Provider Demographics
NPI:1063151959
Name:CONRAD, KASSIDY DELAINE (MASTERS STUDENT)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:DELAINE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MASTERS STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 COUNTRY CLUB RD UNIT 7201
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6167
Mailing Address - Country:US
Mailing Address - Phone:337-529-0337
Mailing Address - Fax:
Practice Address - Street 1:114 STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5718
Practice Address - Country:US
Practice Address - Phone:337-426-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health