Healthcare Provider Details

I. General information

NPI: 1457886103
Provider Name (Legal Business Name): MR. GLERON DESHAE FLEMING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 RICHWOOD ROAD 1
MONROE LA
71202-6894
US

IV. Provider business mailing address

1655 RICHWOOD ROAD 1
MONROE LA
71202-6894
US

V. Phone/Fax

Practice location:
  • Phone: 318-436-8305
  • Fax:
Mailing address:
  • Phone: 318-436-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: