Individual
MRS. LISA LYNN CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LMHC, RBC
Contact information
Practice address
3112 S FAIRINGTON DR, BLOOMINGTON, IN 47403-3914
(812) 333-6536
Mailing address
3112 S FAIRINGTON DR, BLOOMINGTON, IN 47403-3914
(812) 333-6536
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001380A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000512064
ANTHEM
IN
01
—
11607950
CAQH #
IN
Enumeration date
02/06/2006
Last updated
07/08/2007
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