Healthcare Provider Details

I. General information

NPI: 1811660129
Provider Name (Legal Business Name): RHONDA JEAN FLYGARE MA, LADC, LPC SUPERV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHONDA JEAN VOSS NONE

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 CENTRAL AVE NE
MINNEAPOLIS MN
55413-1517
US

IV. Provider business mailing address

1404 CENTRAL AVE NE
MINNEAPOLIS MN
55413-1517
US

V. Phone/Fax

Practice location:
  • Phone: 651-216-4345
  • Fax: 612-789-8087
Mailing address:
  • Phone: 612-216-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305570
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: