Provider Demographics
NPI:1487057691
Name:CARRIGAN, CONNIE (MA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E MAIN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1146
Mailing Address - Country:US
Mailing Address - Phone:509-488-4074
Mailing Address - Fax:
Practice Address - Street 1:425 E MAIN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1146
Practice Address - Country:US
Practice Address - Phone:509-488-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG 60498763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health