Provider Demographics
NPI:1609352822
Name:CONNOLE, KORI L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KORI
Middle Name:L
Last Name:CONNOLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S MAIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3124
Mailing Address - Country:US
Mailing Address - Phone:575-527-0614
Mailing Address - Fax:575-541-4062
Practice Address - Street 1:1605 S MAIN ST BLDG A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3124
Practice Address - Country:US
Practice Address - Phone:575-527-0614
Practice Address - Fax:575-541-4062
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0196541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist