Provider Demographics
NPI:1548923642
Name:FLYNT, AMY (LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FLYNT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELK PL
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-4157
Mailing Address - Country:US
Mailing Address - Phone:303-868-3284
Mailing Address - Fax:
Practice Address - Street 1:7220 W JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2015
Practice Address - Country:US
Practice Address - Phone:303-225-7673
Practice Address - Fax:866-283-0595
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.009923726104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74930371Medicaid