Provider Demographics
NPI:1912317199
Name:FLANAGAN, RIA (MA MFT, LISAC, CSAT)
Entity Type:Individual
Prefix:
First Name:RIA
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MA MFT, LISAC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 W ROOSEVELT ST STE 223
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9306
Mailing Address - Country:US
Mailing Address - Phone:602-698-8990
Mailing Address - Fax:
Practice Address - Street 1:15655 W ROOSEVELT ST STE 223
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9306
Practice Address - Country:US
Practice Address - Phone:602-698-8990
Practice Address - Fax:602-207-8989
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15089101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health