Healthcare Provider Details

I. General information

NPI: 1598161465
Provider Name (Legal Business Name): CARISSA ANN GILLIGAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 04/02/2022
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 WYNKOOP ST
DENVER CO
80202-5925
US

IV. Provider business mailing address

8007 S ADDISON WAY
AURORA CO
80016-7070
US

V. Phone/Fax

Practice location:
  • Phone: 844-843-7279
  • Fax:
Mailing address:
  • Phone: 862-266-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016370
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: