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General NPI Number Information
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NPI Number | 1750277000
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Entity Type | Individual
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Provider Name | MIA FLYNN TLLP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 500 CASCADE WEST PKWY SE STE 240
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2166
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Country | US
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Telephone | 616-591-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 537 HAMPTON LN NW APT 1A
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City | WALKER
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State | MI
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Zip | 49534-7818
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6351004831
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License Number State | MI
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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 | 6351004831
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License Number State | MI
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