Provider Demographics
NPI:1720716673
Name:CONNOLLY, MEAGAN MARIE (PCLC, MFLC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MARIE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PCLC, MFLC
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:MARIE
Other - Last Name:DOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4925
Mailing Address - Country:US
Mailing Address - Phone:406-209-9701
Mailing Address - Fax:
Practice Address - Street 1:48 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4925
Practice Address - Country:US
Practice Address - Phone:406-209-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-56449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional