Healthcare Provider Details

I. General information

NPI: 1316925100
Provider Name (Legal Business Name): MARK CHRISTOPHER FLEMING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 12/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W ELLIOT RD SUITE 220
TEMPE AZ
85284-1144
US

IV. Provider business mailing address

PO BOX 6358
CHANDLER AZ
85246-6358
US

V. Phone/Fax

Practice location:
  • Phone: 410-441-0105
  • Fax: 314-919-9668
Mailing address:
  • Phone: 410-441-0105
  • Fax: 314-919-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB1-0000704
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: