Provider Demographics
NPI:1710549001
Name:FLINN, BRADLEY KEITH (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KEITH
Last Name:FLINN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 HORIZON CT STE 343
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8765
Mailing Address - Country:US
Mailing Address - Phone:650-430-3007
Mailing Address - Fax:
Practice Address - Street 1:743 HORIZON CT STE 343
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8765
Practice Address - Country:US
Practice Address - Phone:650-430-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0015510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COXOtherNO PAYERS YET JUST RECEIVED CREDENIALING