Healthcare Provider Details

I. General information

NPI: 1669117206
Provider Name (Legal Business Name): FLAGTOWN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E ROUTE 66 STE 203
FLAGSTAFF AZ
86001-5777
US

IV. Provider business mailing address

16 E ROUTE 66 STE 203
FLAGSTAFF AZ
86001-5777
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-2907
  • Fax:
Mailing address:
  • Phone: 928-606-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARCA MCCALLIE
Title or Position: PRESIDENT
Credential: PHD, PSY
Phone: 928-606-2907