Provider Demographics
NPI:1225242282
Name:FLENTGE, BRIAN (PPS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FLENTGE
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 RAMBLER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2318
Mailing Address - Country:US
Mailing Address - Phone:916-344-6253
Mailing Address - Fax:
Practice Address - Street 1:1130 CONROY LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4156
Practice Address - Country:US
Practice Address - Phone:916-784-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool