Provider Demographics
NPI:1982016846
Name:CAROL L FLANARY, LLC
Entity Type:Organization
Organization Name:CAROL L FLANARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANARY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:414-339-5559
Mailing Address - Street 1:12645 W BURLEIGH RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3102
Mailing Address - Country:US
Mailing Address - Phone:414-339-5559
Mailing Address - Fax:
Practice Address - Street 1:12645 W BURLEIGH RD
Practice Address - Street 2:SUITE 20
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3102
Practice Address - Country:US
Practice Address - Phone:414-339-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144487844Medicaid