Provider Demographics
NPI:1073011524
Name:KERRIGAN, TRILBY BLYTHE TUESDAY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:TRILBY
Middle Name:BLYTHE TUESDAY
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:LCSW
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 465
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-0465
Mailing Address - Country:US
Mailing Address - Phone:707-380-4351
Mailing Address - Fax:
Practice Address - Street 1:6991 N STATE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9629
Practice Address - Country:US
Practice Address - Phone:707-234-2503
Practice Address - Fax:707-485-5199
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1047561041C0700X
CA78187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health