NPIMap

Organization Active NPI

Fly Family Therapy, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newport News, VA
National Provider Identifier
1881171668
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FLY FAMILY THERAPY, INC.
Practice address
718 J Clyde Morris Blvd Ste D
Newport News, VA 23601-1540
Phone
(757) 873-8566
Fax
(757) 595-1885
NPI assigned
Jul 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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

Authorized official

Name
Kristen L. Fly, LMFTNPI 1548395478
Title
Clinician, Supervisor
Phone
(757) 912-5359

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X VA Primary

Addresses

Primary practice location

718 J Clyde Morris Blvd Ste D
Newport News, VA 23601-1540

Mailing address

718 J Clyde Morris Blvd Ste D
Newport News, VA 23601-1540
Phone (757) 873-8566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200417001638 VA Part B Supplier - Clinic/Group Practice 7315377173 Receives reassigned benefits from 7 practitioners
Practice locations: Newport News, VA; Williamsburg, VA

National Provider Directory

National Provider Directory

Locations

718 J Clyde Morris Blvd
Ste D
Newport News, VA 23601
Phone (757) 873-8566

732 Thimble Shoals Blvd
Ste 203
Newport News, VA 23606
Phone (757) 873-8566

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1881171668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 J CLYDE MORRIS BLVD STE D",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011540",
            "telephone_number": "757-873-8566",
            "fax_number": "757-595-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 J CLYDE MORRIS BLVD STE D",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011540",
            "telephone_number": "757-873-8566",
            "fax_number": "757-595-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLY FAMILY THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "FLY",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CLINICIAN, SUPERVISOR",
        "authorized_official_telephone_number": "757-912-5359",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.