Healthcare Provider Details

I. General information

NPI: 1609377597
Provider Name (Legal Business Name): MAURICE FLEMING LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

PO BOX 2843
ESPANOLA NM
87532-4843
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-2129
  • Fax: 505-992-1149
Mailing address:
  • Phone: 505-501-4217
  • 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: