Healthcare Provider Details

I. General information

NPI: 1356399315
Provider Name (Legal Business Name): JERRY E FLEXMAN, PHD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PLACE WEST PAVILION 1ST FLOOR SUITE C
DAYTON OH
45408
US

IV. Provider business mailing address

PO BOX 190
ALPHA OH
45301-0190
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-5300
  • Fax: 937-258-4162
Mailing address:
  • Phone: 937-427-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE2893
License Number StateOH

VIII. Authorized Official

Name: MR. JERRY E FLEXMAN
Title or Position: DIRECTOR
Credential: PHD
Phone: 937-256-5300