Healthcare Provider Details

I. General information

NPI: 1134902653
Provider Name (Legal Business Name): LAUREN ELIZABETH FLYNN PHD, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 2ND AVE
SAN DIEGO CA
92101-2020
US

IV. Provider business mailing address

4008 PROMONTORY ST
SAN DIEGO CA
92109-5334
US

V. Phone/Fax

Practice location:
  • Phone: 619-848-3450
  • Fax:
Mailing address:
  • Phone: 901-489-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14409
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14409
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC015028
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: