Healthcare Provider Details

I. General information

NPI: 1699811661
Provider Name (Legal Business Name): STACIE LYNN FLYNN MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACIE LYNN GLASER BA

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY NW
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8903 KEY PENINSULA HWY NW
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 415-849-0919
  • Fax:
Mailing address:
  • Phone: 415-849-0919
  • Fax: 253-884-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61199466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: