Healthcare Provider Details

I. General information

NPI: 1083819874
Provider Name (Legal Business Name): NANETTE MICHELLE FLYNN M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

IV. Provider business mailing address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-1210
  • Fax:
Mailing address:
  • Phone: 818-758-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: