Healthcare Provider Details

I. General information

NPI: 1043071871
Provider Name (Legal Business Name): ANDREW M FLYNN AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11341 NATIONAL BLVD # 1140
LOS ANGELES CA
90064-3726
US

IV. Provider business mailing address

11341 NATIONAL BLVD # 1140
LOS ANGELES CA
90064-3726
US

V. Phone/Fax

Practice location:
  • Phone: 213-807-0502
  • Fax:
Mailing address:
  • Phone: 213-807-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT153506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: