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General NPI Number Information
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NPI Number | 1336667104
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Entity Type | Individual
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Provider Name | TOMI LYNNE FLACK LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 640 STATE ROUTE 20 STE A1
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-4315
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Country | US
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Telephone | 360-503-1958
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Fax | 360-854-7138
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Provider Business Mailing Address
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Address Line | 25944 COMMUNITY PLAZA WAY
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-9721
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Country | US
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Telephone | 360-854-7000
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Fax | 360-854-7004
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00007380
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License Number State | WA
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