Provider Demographics
NPI:1336667104
Name:FLACK, TOMI LYNNE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:TOMI
Middle Name:LYNNE
Last Name:FLACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25944 COMMUNITY PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9721
Mailing Address - Country:US
Mailing Address - Phone:360-854-7000
Mailing Address - Fax:360-854-7004
Practice Address - Street 1:640 STATE ROUTE 20 STE A1
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4315
Practice Address - Country:US
Practice Address - Phone:360-503-1958
Practice Address - Fax:360-854-7138
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health