Provider Demographics
NPI:1952603631
Name:MARY L. FLAIM,INC.
Entity Type:Organization
Organization Name:MARY L. FLAIM,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLAIM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:574-277-4985
Mailing Address - Street 1:3130 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4736
Mailing Address - Country:US
Mailing Address - Phone:574-277-4985
Mailing Address - Fax:
Practice Address - Street 1:3130 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4736
Practice Address - Country:US
Practice Address - Phone:574-277-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMF008148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A14526OtherBLUE CROSS MICHIGAN