Healthcare Provider Details

I. General information

NPI: 1972384238
Provider Name (Legal Business Name): ANN MUELLER FLYNT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113B JEFFERSON RD
SOUTH CHARLESTON WV
25309-9780
US

IV. Provider business mailing address

717 BERG DR
CHARLESTON WV
25302-4456
US

V. Phone/Fax

Practice location:
  • Phone: 304-993-3727
  • Fax:
Mailing address:
  • Phone: 304-993-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2852
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: