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General NPI Number Information
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NPI Number | 1619457819
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Entity Type | Individual
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Provider Name | CANDY RENEE TRYGGESTAD LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1307 SW WASHINGTON AVE
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City | LAWTON
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State | OK
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Zip | 73501-7231
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Country | US
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Telephone | 580-355-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 231 MEED CT # 210
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-2486
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Country | US
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Telephone | 828-350-1177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6261
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C014358
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License Number State | NC
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