Healthcare Provider Details

I. General information

NPI: 1972503381
Provider Name (Legal Business Name): PATRICK HENRY FLYNN MS, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 N 15TH ST
LARAMIE WY
82072-2343
US

IV. Provider business mailing address

1263 N 15TH ST
LARAMIE WY
82072-2343
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-8915
  • Fax: 307-745-8761
Mailing address:
  • Phone: 307-745-8915
  • Fax: 307-745-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number010
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: