Healthcare Provider Details

I. General information

NPI: 1538723234
Provider Name (Legal Business Name): JOHN B. FLEMING PHD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 CR 673 # 8938
BUSHNELL FL
33513-8358
US

IV. Provider business mailing address

101 RAINBOW DR
LIVINGSTON TX
77399-9301
US

V. Phone/Fax

Practice location:
  • Phone: 317-699-2171
  • Fax:
Mailing address:
  • Phone: 317-699-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13067
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043656A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20043656B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: