Provider Demographics
NPI:1669871729
Name:FLYTHE, WILLIAM II (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:FLYTHE
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 RUSSELL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3291
Mailing Address - Country:US
Mailing Address - Phone:240-813-4888
Mailing Address - Fax:
Practice Address - Street 1:3535 S RICHEY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-886-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5777101Y00000X
AZLPC5937T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-5937TOtherARIZONA BOARD OF BEHAVIOR HEALTH