Basic Information
| Provider Information | |||||||||
| NPI: | 1619457819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRYGGESTAD | ||||||||
| FirstName: | CANDY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 MEED CT # 210 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283032486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283501177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1307 SW WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735017231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803557500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6261 | OK | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | C014358 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.