Provider Demographics
NPI:1942714902
Name:PATRICIA FLYNN, LAC
Entity Type:Organization
Organization Name:PATRICIA FLYNN, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAC
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-850-4477
Mailing Address - Street 1:PO BOX 20368
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-0368
Mailing Address - Country:US
Mailing Address - Phone:406-850-4477
Mailing Address - Fax:
Practice Address - Street 1:1629 AVENUE D STE B4
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3071
Practice Address - Country:US
Practice Address - Phone:406-850-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0000309261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000309Medicaid