Healthcare Provider Details

I. General information

NPI: 1952761371
Provider Name (Legal Business Name): MEGHAN FLYNT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 CENTRAL AVE
BAY ST LOUIS MS
39520-3913
US

IV. Provider business mailing address

1600 BROAD AVE
GULFPORT MS
39501-3603
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-1881
  • Fax: 228-466-4359
Mailing address:
  • Phone: 228-467-1881
  • Fax: 228-466-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2059
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: