Healthcare Provider Details

I. General information

NPI: 1891837563
Provider Name (Legal Business Name): FLYNN & OWEN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 VILLAGE SQUARE DR SUITE 101
PADUCAH KY
42001-9560
US

IV. Provider business mailing address

5120 VILLAGE SQUARE DR SUITE 101
PADUCAH KY
42001-9560
US

V. Phone/Fax

Practice location:
  • Phone: 270-538-0851
  • Fax: 270-538-0852
Mailing address:
  • Phone: 270-538-0851
  • Fax: 270-538-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1824
License Number StateKY

VIII. Authorized Official

Name: MRS. JILL L FLYNN
Title or Position: OWNER
Credential: LCSW
Phone: 270-538-0851