Provider Demographics
NPI:1982423679
Name:FLANAGAN, JOHN BRANDENBURG
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRANDENBURG
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WARHAWK WAY
Mailing Address - Street 2:UNIT A4
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:443-807-4831
Mailing Address - Fax:
Practice Address - Street 1:161 COMEAUX ROAD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269
Practice Address - Country:US
Practice Address - Phone:318-303-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)