Provider Demographics
NPI:1043629207
Name:CONRAD, JACINDA (PSYD, LPC)
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10548 W BUSINESS PARK LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6797
Mailing Address - Country:US
Mailing Address - Phone:208-890-7165
Mailing Address - Fax:
Practice Address - Street 1:10548 W BUSINESS PARK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6797
Practice Address - Country:US
Practice Address - Phone:208-890-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10212101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)