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General NPI Number Information
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NPI Number | 1548350457
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Entity Type | Individual
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Provider Name | MELLANY K FLYNN PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 10809 EXECUTIVE CENTER DR STE 105
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City | LITTLE ROCK
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State | AR
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Zip | 72211-6020
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Country | US
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Telephone | 501-551-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 10809 EXECUTIVE CENTER DR STE 105
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City | LITTLE ROCK
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State | AR
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Zip | 72211-6020
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Country | US
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Telephone | 501-551-5065
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 05-17P
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License Number State | AR
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