Provider Demographics
NPI:1548382211
Name:FLYNN, VEDA ROCHELLE (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:VEDA
Middle Name:ROCHELLE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13042 LORETTA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1820
Mailing Address - Country:US
Mailing Address - Phone:714-336-9611
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-523-9500
Practice Address - Fax:310-225-2725
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF42762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007570Medicaid
CACBSC825OtherLA DMH PROVIDER