Healthcare Provider Details

I. General information

NPI: 1275589798
Provider Name (Legal Business Name): JOANN FLANAGAN L.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 RESERVATION RD
RENO NV
89502-1521
US

IV. Provider business mailing address

34 RESERVATION RD
RENO NV
89502-1521
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-5162
  • Fax: 775-789-5613
Mailing address:
  • Phone: 775-329-5162
  • Fax: 775-789-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number262-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: