Healthcare Provider Details

I. General information

NPI: 1386835395
Provider Name (Legal Business Name): JOHN WESLEY FLEEKER LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/26/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7348 W. 21RST. N. SUITE 107
WICHITA KS
67205
US

IV. Provider business mailing address

PO BOX 130 801 COFFMAN
WHITEWATER CO
81527
US

V. Phone/Fax

Practice location:
  • Phone: 316-779-2560
  • Fax:
Mailing address:
  • Phone: 970-255-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number801
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number319
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: