Healthcare Provider Details

I. General information

NPI: 1447322565
Provider Name (Legal Business Name): TOM J FLANAGAN JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TOM J FLANAGAN LCSW

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 THOMPSON RD
DE SOTO MO
63020-5299
US

IV. Provider business mailing address

3066 THOMPSON RD
DE SOTO MO
63020-5299
US

V. Phone/Fax

Practice location:
  • Phone: 913-963-4507
  • Fax:
Mailing address:
  • Phone: 913-963-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: