Healthcare Provider Details

I. General information

NPI: 1669887824
Provider Name (Legal Business Name): CATHY FLYNT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 HISTORIC 66 W STE 101
WAYNESVILLE MO
65583-8322
US

IV. Provider business mailing address

19781 SUGAR LN
WAYNESVILLE MO
65583-3355
US

V. Phone/Fax

Practice location:
  • Phone: 573-433-4846
  • Fax:
Mailing address:
  • Phone: 573-433-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014014452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: