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General NPI Number Information
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NPI Number | 1255782868
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Entity Type | Individual
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Provider Name | ALEXIS FLYNN
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Gender | Female
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 11 GOLDEN SHR STE 350
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City | LONG BEACH
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State | CA
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Zip | 90802-4279
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Country | US
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Telephone | 888-588-8995
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 981043
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City | PARK CITY
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State | UT
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Zip | 84098-1043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW86666
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License Number State | CA
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