Provider Demographics
NPI:1881799609
Name:FLANAGAN, MARY H (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3407 BERRYWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6500
Mailing Address - Country:US
Mailing Address - Phone:573-443-1177
Mailing Address - Fax:573-499-1564
Practice Address - Street 1:3407 BERRYWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6500
Practice Address - Country:US
Practice Address - Phone:573-443-1177
Practice Address - Fax:573-499-1564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling