Provider Demographics
NPI:1134461130
Name:FLYNN, KATHERINE M
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13185 W 62ND PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3825
Mailing Address - Country:US
Mailing Address - Phone:936-827-3187
Mailing Address - Fax:
Practice Address - Street 1:1200 W SOUTH BOULDER RD
Practice Address - Street 2:203
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3546
Practice Address - Country:US
Practice Address - Phone:720-837-2348
Practice Address - Fax:303-554-5657
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-12-10425103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst