Provider Demographics
NPI:1366083438
Name:FLANNAGAN, JOHN ARTHUR (LPCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ARTHUR
Last Name:FLANNAGAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:ARTHUR
Other - Last Name:FLANNAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:4037 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3243
Mailing Address - Country:US
Mailing Address - Phone:612-825-9019
Mailing Address - Fax:
Practice Address - Street 1:4037 13TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3243
Practice Address - Country:US
Practice Address - Phone:612-825-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty