Provider Demographics
NPI:1548350457
Name:FLYNN, MELLANY K (PSYD)
Entity type:Individual
Prefix:
First Name:MELLANY
Middle Name:K
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 EXECUTIVE CENTER DR
Mailing Address - Street 2:STE 105
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-6020
Mailing Address - Country:US
Mailing Address - Phone:501-551-5065
Mailing Address - Fax:
Practice Address - Street 1:10809 EXECUTIVE CENTER DR
Practice Address - Street 2:STE 105
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-6020
Practice Address - Country:US
Practice Address - Phone:501-551-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05-17P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164427719Medicaid
AR164427719Medicaid