Provider Demographics
NPI:1811607120
Name:FLYNN, JOHN TYLER (TCADC, TCM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:FLYNN
Suffix:
Gender:
Credentials:TCADC, TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N CLIFTON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2438
Mailing Address - Country:US
Mailing Address - Phone:502-496-4928
Mailing Address - Fax:
Practice Address - Street 1:225 N CLIFTON AVE STE 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2438
Practice Address - Country:US
Practice Address - Phone:502-496-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270902101YA0400X
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)