Provider Demographics
NPI:1790056570
Name:FLYNN, LAURA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NE 83RD ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4400
Mailing Address - Country:US
Mailing Address - Phone:816-468-0400
Mailing Address - Fax:816-468-6623
Practice Address - Street 1:3100 NE 83RD ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4400
Practice Address - Country:US
Practice Address - Phone:816-468-0400
Practice Address - Fax:816-468-6623
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011033589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist