Healthcare Provider Details

I. General information

NPI: 1710505722
Provider Name (Legal Business Name): CHRISTOPHER FLYNN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W HORIZON RIDGE PKWY
HENDERSON NV
89012-5202
US

IV. Provider business mailing address

540 W HORIZON RIDGE PKWY
HENDERSON NV
89012-5202
US

V. Phone/Fax

Practice location:
  • Phone: 323-202-9382
  • Fax:
Mailing address:
  • Phone: 323-202-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: