Active NPI
Mark Lyndel Conley, DAC
- Addiction (Substance Use Disorder) Counselor
- Red Bluff, CA
National Provider Identifier
1972849503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 03-040789
- Practice address
- 1850 Walnut St BLDG G
Red Bluff, CA 96080-3611 - Phone
- (530) 527-7893
- Fax
- (530) 527-0766
- NPI assigned
- Dec 31, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 03-040789 | CA | Primary |
Addresses
Primary practice location
1850 Walnut St BLDG G
Red Bluff, CA 96080-3611
Mailing address
PO Box 400
Red Bluff, CA 96080-0400
Phone (530) 527-7893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03-040789 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356912000000",
"number": "1972849503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "RED BLUFF",
"state": "CA",
"postal_code": "960800400",
"telephone_number": "530-527-7893",
"fax_number": "530-527-0766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 WALNUT ST BLDG G",
"city": "RED BLUFF",
"state": "CA",
"postal_code": "960803611",
"telephone_number": "530-527-7893",
"fax_number": "530-527-0766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONLEY",
"first_name": "MARK",
"middle_name": "LYNDEL",
"name_prefix": "Mr.",
"credential": "DAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-12-31",
"last_updated": "2012-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "03-040789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Bluff, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.