Healthcare Provider Details

I. General information

NPI: 1588757405
Provider Name (Legal Business Name): TIMOTHY J. FLYNN M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 EAST GREEN BAY ST., STE 191 SYNERGY COUNSELING SERVICES, SC
SHAWANO WI
54166-3881
US

IV. Provider business mailing address

1415 EAST GREEN BAY ST., STE. 191 SYNERGY COUNSELING SERVICES, SC
SHAWANO WI
54166-3881
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-5466
  • Fax: 715-526-5545
Mailing address:
  • Phone: 715-526-5466
  • Fax: 715-526-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number653125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10996
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number653-125
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10996-131
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: