Healthcare Provider Details

I. General information

NPI: 1922672781
Provider Name (Legal Business Name): LAURA FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E BOGARD RD BLDG 2
WASILLA AK
99654-4711
US

IV. Provider business mailing address

PO BOX 876741
WASILLA AK
99687-6741
US

V. Phone/Fax

Practice location:
  • Phone: 73-734-7329
  • Fax: 907-746-4749
Mailing address:
  • Phone: 907-373-4732
  • Fax: 907-746-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: