Provider Demographics
NPI:1578621306
Name:CARRIGAN, JASON L
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:CARRIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WASHINGTON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2609
Mailing Address - Country:US
Mailing Address - Phone:816-756-3858
Mailing Address - Fax:
Practice Address - Street 1:4010 WASHINGTON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2609
Practice Address - Country:US
Practice Address - Phone:816-756-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000696101YM0800X
KS112101YM0800X
KS062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist