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General NPI Number Information
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NPI Number | 1427460948
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Entity Type | Individual
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Provider Name | SUSAN FLACK LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 2711 N 21ST ST
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City | TACOMA
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State | WA
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Zip | 98406-7519
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Country | US
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Telephone | 206-422-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 6409 54TH ST NW
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City | GIG HARBOR
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State | WA
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Zip | 98335-6649
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Country | US
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Telephone | 206-696-3365
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60980741
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License Number State | WA
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