| Fayvonne Flourish, Pllc | |
|
412 Millard St Georgetown TX 78628-2024 | |
| (512) 828-2367 | |
| Not Available |
| Full Name | Fayvonne Flourish, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 412 Millard St, Georgetown, Texas |
| Authorized Official Name and Position | Robin Fayvonne Johnson (OWNER) |
| Authorized Official Contact | 5128282367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayvonne Flourish, Pllc 412 Millard St Georgetown TX 78628-2024 Ph: (512) 333-1458 | Fayvonne Flourish, Pllc 412 Millard St Georgetown TX 78628-2024 Ph: (512) 828-2367 |
| NPI Number | 1417549890 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/01/2021 |
| Medicare PECOS PAC ID | 6103231295 |
|---|---|
| Medicare Enrollment ID | O20210223002813 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417549890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Robin F Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164067062 PECOS PAC ID: 0244645273 Enrollment ID: I20210224001819 |
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