Provider Demographics
NPI:1134902653
Name:FLYNN, LAUREN ELIZABETH (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:FLYNN
Suffix:
Gender:
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 PROMONTORY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5334
Mailing Address - Country:US
Mailing Address - Phone:901-489-6611
Mailing Address - Fax:
Practice Address - Street 1:2214 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2020
Practice Address - Country:US
Practice Address - Phone:619-848-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14409101Y00000X, 101YM0800X
GALPC015028101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC015028OtherGEORGIA LICENSE