Provider Demographics
NPI:1922779586
Name:FLINT, CHARLES DALE (BS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DALE
Last Name:FLINT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:DALE
Other - Last Name:FLINT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:345 N STATE ROAD 198
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 N STATE ROAD 198
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5719
Practice Address - Country:US
Practice Address - Phone:801-423-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician