Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH13594 | FL |
N | 101YP2500X | Professional Counselor | MH13594 | FL |
N | 101YS0200X | School Counselor | 1080175 | FL |
NPI | 1073924700 |
---|---|
Provider Name | Jacqueline Flynn |
First Address | Cocoa, FL 32927-2929 |
Second Address | Cocoa, FL 32922-3623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 18/03/2016 |