Healthcare Provider Details

I. General information

NPI: 1376367623
Provider Name (Legal Business Name): COLLIN FLAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S PATTERSON BLVD
DAYTON OH
45402-2624
US

IV. Provider business mailing address

865 S PATTERSON BLVD
DAYTON OH
45402-2624
US

V. Phone/Fax

Practice location:
  • Phone: 937-966-4673
  • Fax:
Mailing address:
  • Phone: 937-966-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: