Provider Demographics
NPI:1003302738
Name:MCCONNELL, MARIAH ANN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ANN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:ANN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7356 VILLAGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4028
Mailing Address - Country:US
Mailing Address - Phone:719-428-1381
Mailing Address - Fax:
Practice Address - Street 1:4775 BARNES RD STE L
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1650
Practice Address - Country:US
Practice Address - Phone:719-644-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016182101YM0800X
LPC.0016772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health