Provider Demographics
NPI:1306348495
Name:CONNAUGHTY, TODD JAMES (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JAMES
Last Name:CONNAUGHTY
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HIGHWAY 100 S APT 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2146
Mailing Address - Country:US
Mailing Address - Phone:612-719-3091
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWAY 100 S APT 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2146
Practice Address - Country:US
Practice Address - Phone:612-719-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health