Individual
TYLER CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
165 LANCASTER ST, PORTLAND, ME 04101-2406
(260) 318-4422
Mailing address
165 LANCASTER ST, PORTLAND, ME 04101-2406
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC6615
ME
Other
Enumeration date
01/24/2020
Last updated
08/16/2022
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