Provider Demographics
NPI:1699811661
Name:FLYNN, STACIE LYNN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:GLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:7500 OLD MILITARY RD NE STE 103
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3242
Mailing Address - Country:US
Mailing Address - Phone:360-698-9258
Mailing Address - Fax:
Practice Address - Street 1:8903 KEY PENINSULA HWY NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:415-849-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61199466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health