Provider Demographics
NPI:1457033193
Name:FLENTYE, EMILY ALYCE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ALYCE
Last Name:FLENTYE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S. POWER RPAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-8332
Mailing Address - Country:US
Mailing Address - Phone:844-385-3747
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6687
Practice Address - Country:US
Practice Address - Phone:844-385-3747
Practice Address - Fax:480-462-2801
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22015101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty