Provider Demographics
NPI:1790494169
Name:FLINT, MARK WESLEY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WESLEY
Last Name:FLINT
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 1:115 N 7TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2710
Mailing Address - Country:US
Mailing Address - Phone:605-645-0100
Mailing Address - Fax:605-717-1009
Practice Address - Street 1:115 N 7TH ST STE 6
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2710
Practice Address - Country:US
Practice Address - Phone:605-645-0100
Practice Address - Fax:605-717-1009
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3005995Medicaid