Healthcare Provider Details

I. General information

NPI: 1760871586
Provider Name (Legal Business Name): DAVID FLYNN LPCI, QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SW ACADEMY ST
DALLAS OR
97338-1996
US

IV. Provider business mailing address

182 SW ACADEMY ST
DALLAS OR
97338-1996
US

V. Phone/Fax

Practice location:
  • Phone: 971-301-4620
  • Fax:
Mailing address:
  • Phone:
  • 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: