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NPI Code Detail

MEDICARE: TIMOTHY EDWARD FLYNN B.A. PHILOSOPHY, CRM

MEDICARE: TIMOTHY EDWARD FLYNN B.A. PHILOSOPHY, CRM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor106697OR

General Provider Information

NPI Number : 1104535103
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY EDWARD FLYNN B.A. PHILOSOPHY, CRM
Provider Business Mailing Address
First Line : 1100 JACKSON ST SE
Second Line :
City : ALBANY
State : OR
Zip : 97322-3244
Country : US
Telephone Number : 541-967-8545
Fax Number :
Provider Business Practice Location Address
First Line : 1100 JACKSON ST SE
Second Line :
City : ALBANY
State : OR
Zip : 97322-3244
Country : US
Telephone Number : 541-967-8545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2022
Last Update Date : 11/17/2022

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