Provider Demographics
NPI:1396288312
Name:GREEN FLYNN, EMILY CATHERINE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CATHERINE
Last Name:GREEN FLYNN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:CATHERINE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 5158
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5158
Mailing Address - Country:US
Mailing Address - Phone:864-594-9459
Mailing Address - Fax:864-241-8189
Practice Address - Street 1:460 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1614
Practice Address - Country:US
Practice Address - Phone:864-582-2411
Practice Address - Fax:864-582-7178
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC8150106H00000X, 101Y00000X
SC8113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC031100Medicaid
SC3333Medicare PIN