Provider Demographics
NPI:1245552876
Name:BECKY DURHAM-FLINT, P.A.
Entity type:Organization
Organization Name:BECKY DURHAM-FLINT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:321-733-2299
Mailing Address - Street 1:105 S RIVERSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4365
Mailing Address - Country:US
Mailing Address - Phone:321-733-2299
Mailing Address - Fax:321-733-7515
Practice Address - Street 1:105 S RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4365
Practice Address - Country:US
Practice Address - Phone:321-733-2299
Practice Address - Fax:321-733-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3348Medicare UPIN