Healthcare Provider Details

I. General information

NPI: 1912317199
Provider Name (Legal Business Name): RIA FLANAGAN MA MFT, LISAC, CSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 W ROOSEVELT ST STE 223
GOODYEAR AZ
85338-9306
US

IV. Provider business mailing address

15655 W ROOSEVELT ST STE 223
GOODYEAR AZ
85338-9306
US

V. Phone/Fax

Practice location:
  • Phone: 602-698-8990
  • Fax: 602-207-8989
Mailing address:
  • Phone: 602-698-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15089
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLISAC-15089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: