Provider Demographics
NPI:1760541429
Name:GARY M FLYNN
Entity Type:Organization
Organization Name:GARY M FLYNN
Other - Org Name:COUNSELING RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-454-3880
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-0323
Mailing Address - Country:US
Mailing Address - Phone:507-454-3880
Mailing Address - Fax:507-474-0383
Practice Address - Street 1:506 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5233
Practice Address - Country:US
Practice Address - Phone:507-454-3880
Practice Address - Fax:507-474-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30472COOtherBCBS ID#