Provider Demographics
NPI:1215062716
Name:CONRAD, CHEL SEA
Entity type:Individual
Prefix:
First Name:CHEL
Middle Name:SEA
Last Name:CONRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANNE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:NICE
Mailing Address - State:CA
Mailing Address - Zip Code:95464
Mailing Address - Country:US
Mailing Address - Phone:707-274-8400
Mailing Address - Fax:
Practice Address - Street 1:914 MISSON AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:415-721-0281
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health