Healthcare Provider Details

I. General information

NPI: 1255782868
Provider Name (Legal Business Name): ALEXIS FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GOLDEN SHR STE 350
LONG BEACH CA
90802-4279
US

IV. Provider business mailing address

PO BOX 981043
PARK CITY UT
84098-1043
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW86666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: