Healthcare Provider Details

I. General information

NPI: 1265694004
Provider Name (Legal Business Name): MARY KATHLEEN FLYNN LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N LORRAINE ST SUITE 202
HUTCHINSON KS
67501-5670
US

IV. Provider business mailing address

1600 N LORRAINE ST SUITE 202
HUTCHINSON KS
67501-5670
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7595
  • Fax: 620-728-2037
Mailing address:
  • Phone: 620-663-7595
  • Fax: 620-728-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1154
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: