Provider Demographics
NPI:1588996912
Name:FLANIGAN, MARILYN YVONNE
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:YVONNE
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:YVONNE
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 KNOLLCREST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0181
Mailing Address - Country:US
Mailing Address - Phone:530-392-4399
Mailing Address - Fax:
Practice Address - Street 1:415 KNOLLCREST DR STE 101
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0181
Practice Address - Country:US
Practice Address - Phone:530-392-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 97326106H00000X, 106H00000X
CAIMF 91444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist