Healthcare Provider Details

I. General information

NPI: 1255932695
Provider Name (Legal Business Name): JESSICA FLETCHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E MONTEREY WAY
PHOENIX AZ
85012-2620
US

IV. Provider business mailing address

214 E MONTEREY WAY
PHOENIX AZ
85012-2620
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-6949
  • Fax:
Mailing address:
  • Phone: 480-206-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-19389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: