Healthcare Provider Details

I. General information

NPI: 1437442712
Provider Name (Legal Business Name): LAWRENCE L FLYNN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WESTLAND RD SUITE C
CHEYENNE WY
82001-3309
US

IV. Provider business mailing address

2000 WESTLAND RD SUITE C
CHEYENNE WY
82001-3309
US

V. Phone/Fax

Practice location:
  • Phone: 307-399-5277
  • Fax:
Mailing address:
  • Phone: 307-699-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-447
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: