Evan Joseph Flack, MA, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305876 Issued in MN

Practice address

762 Transfer Rd Ste 21
Saint Paul, MN 55114-1489

Phone

(651) 659-2900

NPI assigned

May 24, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1255079752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 CUSHING CIR APT 309",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 TRANSFER RD STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141489",
            "telephone_number": "651-659-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "EVAN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "MA, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-24",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.