MEDICARE: MS. MARY ANN FLICKINGER MA MED LPCC LSW NCC

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
1	101YM0800X	Mental Health Counselor	E2816	OH

General Provider Information

NPI Number	:	1518996362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ANN FLICKINGER MA MED LPCC LSW NCC

Provider Business Mailing Address
First Line	:	2504 MONTANA AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3766
Country	:	US
Telephone Number	:	513-662-1306
Fax Number	:	513-947-9103

Provider Business Practice Location Address
First Line	:	1324 STATE ROUTE 125
Second Line	:	SUITE 202
City	:	AMELIA
State	:	OH
Zip	:	45102-1360
Country	:	US
Telephone Number	:	513-752-5103
Fax Number	:	513-947-9103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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