Provider Demographics
NPI:1447848692
Name:CONWAY, SAMUEL LEHMAN (LPCC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEHMAN
Last Name:CONWAY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 PORTLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1027
Mailing Address - Country:US
Mailing Address - Phone:320-290-7330
Mailing Address - Fax:
Practice Address - Street 1:1350 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1802
Practice Address - Country:US
Practice Address - Phone:651-487-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health