Provider Demographics
NPI:1568530103
Name:FLACK, AMY (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FLACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8763 E EASTMAN PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4506
Mailing Address - Country:US
Mailing Address - Phone:720-581-1425
Mailing Address - Fax:
Practice Address - Street 1:6059 S QUEBEC ST STE 203
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-4523
Practice Address - Country:US
Practice Address - Phone:720-581-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical