Provider Demographics
NPI:1104109743
Name:CONNOLE, MARAH LYNN (MS, LCPC)
Entity type:Individual
Prefix:
First Name:MARAH
Middle Name:LYNN
Last Name:CONNOLE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624
Mailing Address - Country:US
Mailing Address - Phone:406-518-1165
Mailing Address - Fax:
Practice Address - Street 1:2728 COLONIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4922
Practice Address - Country:US
Practice Address - Phone:406-518-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-7710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional