Healthcare Provider Details

I. General information

NPI: 1326352543
Provider Name (Legal Business Name): CHRISTINE E FLYNN MHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E GOBBI ST
UKIAH CA
95482-5511
US

IV. Provider business mailing address

3408 PRIMROSE DR
WILLITS CA
95490-8538
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-2922
  • Fax:
Mailing address:
  • Phone: 707-462-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: