Provider Demographics
NPI:1730609975
Name:FLANNERY, KATHRYN (TLLP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 ARBORVIEW DR APT 22
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7368
Mailing Address - Country:US
Mailing Address - Phone:314-477-5018
Mailing Address - Fax:
Practice Address - Street 1:421 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2477
Practice Address - Country:US
Practice Address - Phone:231-775-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015684102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst