Basic Information
| Provider Information | |||||||||
| NPI: | 1104109743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNOLE | ||||||||
| FirstName: | MARAH | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MS, LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3240 DREDGE DR | ||||||||
| Address2: | INTERMOUNTAIN | ||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596020548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2728 COLONIAL DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596014922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065181165 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2011 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | SWP-LCPC-LIC-7710 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.